Apply to Work With Me

ONLY THOSE WHO ARE SERIOUS ABOUT LEVELING UP THEIR HEALTH,

SHOULD HIT NEXT.

How long has this been going on?

What Triggers it most?

Do you have symptoms into the leg?

Have you been diagnosed with disc bulge/hernation or Sciatica?

How much is this impacting your life right now?

what do you want to be able to do again without worrying about your back/hips?

PT

Chiro

Massage/Stretching

Meds/Injections

Youtube/Self Help

Nothing

What do you think is missing from what you’ve tried?

If we built a plan that clearly fits your situation, are you ready to follow it consistently for 3-6 Months?(required)

Yes Maybe/depends No

A proper plan usually requires some investment. If accepted, are you currently able to invest in professional help?(required)

Yes Maybe/depends No

If “maybe/no,” what would need to change for you to be able to move forward?(required)

Yes Maybe/depends No

First Name

Phone number

Email