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Step 1: Pain Assessment Survey

Please take a moment to complete this short survey. This helps us prepare the most beneficial session for our first time visitors.

To your health!

Craig

Full Name

Email *

Phone *

I agree to receive to receive promotional and reminder text messages from Pain Release Therapy. You also agree to our Privacy Policy & Terms of Use. This agreement isn't a condition of purchase. Message and data rates may apply. Reply STOP at any time to opt out.

What type of massage are you interested in? *

Pain Massage (Therapeutic)

Deep Tissue Massage

Swedish Massage

Sports Massage

Location: Where is the pain located? *

Severity: How severe is your pain on a scale of 0 (no pain) to 10 (worst pain imaginable)? *

Between 1 & 3

Between 4 and 7

Between 8 and 10

Duration: How long have you been experiencing this pain?

A few days