Discovery Session

First Name

Last Name

Primary reason for wanting to speak with Andrew

I'm in lots of pain and want some tips and advice I can start using right away

I want to know what is wrong and how long it will take to ease the pain

I'm not sure if physical therapy is right for me

I'm interested in the benefits of dry needling

Interested in a muscle/joint exam

What does it prevent or stop you from doing?

What are your main worries or concern(s)?

Not knowing what is wrong

No signs of improvement and fear of getting worse

Fear of surgery

The pain I am experiencing

Inability to participate in pleasurable activities

Other

What is the most important thing you want from physical therapy?

Best time for a call back?

During the Day

After 5PM

Anytime

What is your phone number?

What is your email address?

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