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Knee Pain Protocol Survey

What activities cause you to experience knee pain?

Please select all that apply.

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Knee Pain Protocol Survey

Duration of Condition:

How long have you been experiencing your symptoms?

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Knee Pain Protocol Survey

Severity of Condition:

On a scale of 1-10 How would you rate the severity of your symptoms?

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Knee Pain Protocol Survey

Previous Treatments:

What have you done in the past to treat your knee pain?

Please select all that apply.

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Knee Pain Protocol Survey

On a Scale of 1 – 10 with 1 being the lowest level of success and 10 being the highest, How well have you been able to manage your symptoms with your past treatments?

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Knee Pain Protocol Survey

Treatment Goals and Expectations:

What are your primary goals and expectations from a treatment for knee pain?

Please select all that apply.

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Knee Pain Protocol Survey

We offer some of the most advanced therapies available.

In some cases, we offer flexible financing options for individuals who want to take advantage of these therapies.

What best describes your current credit profile?

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Knee Pain Protocol Survey

Comments and Concerns:

Is there any additional information you would like to share with the Doctor before we contact you?

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Knee Pain Protocol Survey

Before we begin, please provide your contact information.

If you are a good candidate, someone from our team will contact you within one business day.