Skip to content
Home
About
Testimonials
Services
Blog
Contact
Menu
Home
About
Testimonials
Services
Blog
Contact
Instant Pain Assessment
Step
1
of
6
16%
This short assessment is easy to complete and will help me with my initial assessment of which program of pain relief is the best fit for you.
Where do you experience the most pain?
*
Check all that apply
Neck
Back
Shoulder
Somewhere else
Where else do you experience pain?
What level of pain are you experiencing?
*
On a scale of 1 to 10 where 10 = extreme 1 = mildly uncomfortable
Between Levels 1 and 3
Between Levels 4 and 7
Between Levels 8 and 10
How long has this pain been bothering you?
*
Four weeks or less
More than a month
More than six months
More than a year
What kind of therapy have you tried for your pain?
*
Chiropractors
Massage Therapy
Physical Therapy
Other
What other pain therapy have you tried?
*
Are you currently seeing anyone for your pain?
*
Yes
No
Is your pain affecting how you sleep?
*
Yes
No
Are you currently taking any medication for pain?
*
Prescribed or over the counter.
Yes
No
After you submit your information I will contact you for a telephone follow-up. You will also be entitled to receive a complete no-cost pain relief assessment at my Summerlin studio.
If you are experiencing chronic pain at level 8 or greater please call me immediately at (702) 275-2840
Submit your information to receive a no-cost pain relief assessment at my Summerlin studio.
Name
*
First
Phone
*
Email
Best time to contact you
Morning
Afternoon
Early evening