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How did you hear about us? How did you hear about us? Youtube Video Yelp Web Search for our Articles (google, bing, etc.) Referred by someone Restoring Human Movement Podcast Other

Are you over 18 years old? Are you over 18 years old? Yes No

Are you local to the Southern CA area? Are you local to the Southern CA area? Yes No

What would you want help with? What would you want help with? Sports Hernia Groin Pain (Front Of Hip Crease) Lower Back/ Sacral Lower Abdominal Region Heel or Foot Testicular Tightness Neck or Shoulder Region Hand Problems Muscle strain Middle Back Ache Elbow/ Forearm Other Region or Condition

How long have you been dealing with this issue? How long have you been dealing with this issue? Weeks Months Years

What concerns you most about your situation? What concerns you most about your situation? Not knowing what's wrong Depending upon painkillers Losing mobility or independence The risk of facing dangerous surgery Not being able to workout/stay active Not being able to play sports

Are you committed to finding a long-term solution to your pain? Are you committed to finding a long-term solution to your pain? Yes No

What's the #1 thing you'd like to achieve!?

What type of care are you looking for? What type of care are you looking for? A comprehensive rehabilitation plan customized specifically for my goals Just a quick adjustment Injury prevention Performance

What is your biggest objection to committing to a plan of care? What is your biggest objection to committing to a plan of care? Time Money Fear of wasting more time and money on something that doesn't help None - I'll do what is needed to improve Other

Are you willing to invest in yourself and your health? Are you willing to invest in yourself and your health? Yes No