Complete this Survey

to see if You qualify for

the Pain Free Future Program

  1. Where is your primary pain located?

*Select all that apply

  1. How long have you been experiencing this pain?

*Select one

  1. What best describes the severity of your pain on average?

*Select one

  1. How often does the pain interfere with your daily activities or lifestyle?

*Select one

  1. What treatments have you tried so far?

*Select all that apply

  1. How effective were these treatments for you?

*Select one

  1. Which statement best describes your current situation?

*Select one

  1. What is your primary goal for care?

*Select one

  1. Our program is a structured corrective protocol that starts with 3 visits per week for the first 6 weeks.

    Are you able to commit to this schedule?

*Select one

  1. This is a “done-for-you and done-with-you” program that requires at-home exercises between visits.

    Are you willing to follow the plan to get the best results?

*Select one

  1. This corrective care program ranges from $6,000–$10,000 depending on what your unique condition requires.

    Which statement best describes you?

*Select one

  1. We offer flexible payment plans, financing, and monthly options. Would you like information on financing?

*Select one

  1. How soon are you looking to start care?

*Select one

Preferred contact method

*Select one

Thank you for filling out this survey!

You May Be a Candidate for the Pain Free Future Method

Based on your answers, you may qualify for our 12-week corrective care program.

The next step is to schedule your Pain Free Future Discovery Call, where we will determine if a Trial is an appropriate next step.

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