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3126 S Higley Rd #102, Gilbert, AZ 85295
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(602) 833-4014
#1 Back Pain Relief Program
in the
Gilbert area!
Get Back Pain Relief
Without
Drugs, injections, or Surgery!
Take this Short Questionnaire to See if You're Eligible!
Who is this for?
*
Myself
Spouse
Child
Parent
What types of back pain symptoms are you experiencing?
*
๐๐ฎ๐ฅ๐ฅ, aching pain
๐๐ฎ๐ฌ๐๐ฅ๐ ๐ฌ๐ฉ๐๐ฌ๐ฆ๐ฌ or stiffness
๐๐ก๐๐ซ๐ฉ or stabbing back pain
Pain that ๐ซ๐๐๐ข๐๐ญ๐๐ฌ down the legs
Pain ๐ฐ๐ก๐ข๐ฅ๐ ๐ฐ๐๐ฅ๐ค๐ข๐ง๐ short distances
๐๐ข๐๐๐ข๐๐ฎ๐ฅ๐ญ๐ฒ ๐ฌ๐ญ๐๐ง๐๐ข๐ง๐ or sitting for long periods
On a scale of 1 to 5, how severe is your pain?
*
1๏ธโฃ Minimal discomfort
2๏ธโฃ Mild pain
3๏ธโฃ Moderate pain
4๏ธโฃ Significant pain
5๏ธโฃ Severe and debilitating pain
How long have you been experiencing these symptoms?
*
Less than 6 months
6 months to 1 year
1-3 years
Over 3 years
Have you been told by a doctor that you might need surgery?
*
Yes
No
Not sure
Have you been diagnosed with any of the following conditions?
*
Herniated or bulging disc
Sciatica
Stenosis
Scoliosis
Degenerative disc disease
I have not been diagnosed with a specific condition
What treatments have you tried for your pain?
*
Pain medications (e.g., opioids, NSAIDs, muscle relaxers)
Steroid injections
Surgery
I havenโt tried any treatments yet
Financing options are available based on credit approval. Which best describes your credit range?
*
Below 650
650-700
700-750
750+
What is your zip code? (This helps us ensure we are serving the right areas.)
*
Full Name
*
What is the best phone number to reach you?
*
Our Location
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