Where is the source of your pain? (Click Next Below 👇 to Select)
Choose all options that apply.
Please rate your pain from 1 - 5.
(1 = no pain), (10 = excruciating pain)
Have you had any surgeries to your existing pain or any other pain condition?
Which insurance (if any) do you have? (We are NOT a Medicaid provider)
CONGRATULATIONS, you qualify for our chiropractic care.
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