First Name *

Last Name *

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Comments

Acute and Chronic Joint Conditions and Injuries

Upper: (Shoulder, Elbow, Wrist Pain)

Lower: (Hip, Knew Ankle Pain)

Neck Pain (Cervicalgia)

Back Pain (Dorsalgia, Sciatica)

Ligament and Tendon Sprains and Tears

Muscle Strains and Tears

Degenerative Disc Disease

Ruptured or Herniated Disc

Delayed Healing of Fractures or Other Trauma

Post-Surgical Pain or Delayed Healing

Overuse Injury – Pain and Dysfunction Caused by Repetitive Use

When did you first notice your pain/problem?

What medications do you take to control the pain?