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Step
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TAKE OUR 10 SECOND QUIZ
Find Out If You Qualify for a FREE Consultation / Knee Assessment
Which Condition Are You Currently Experiencing?
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Meniscal Tears
Osteoarthritis
Bone on bone
Knee Injury
Rate Your Daily Pain
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1
2
3
4
5
6
7
8
9
10
Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Yes
No
Are you currently a patient at another knee pain office or clinic?
*
Yes
No
When are you looking to get results?
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Immediately
2 weeks
60 days
90 days and up
What type of Insurance do you have?
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Original Medicare (red, white and blue card)
Medicare with supplimental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield
Cigna
United Healthcare Advantage
Aetna
I have insurance through my employer
other insurance / I'm not sure what plan I have
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
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Last
Email
*
Phone
*
*
I acknowledge that upon submitting this assessment I will be contacted via phone, email, or SMS by a treatment coordinator with a follow-up discussion within 24-48 hours.
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"
*
" indicates required fields
Step
1
of
7
14%
TAKE OUR 10 SECOND QUIZ
Find Out If You Qualify for a FREE Consultation / Knee Assessment
Which Condition Are You Currently Experiencing?
*
Meniscal Tears
Osteoarthritis
Bone on bone
Knee Injury
Rate Your Daily Pain
*
1
2
3
4
5
6
7
8
9
10
Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
Yes
No
Are you currently a patient at another knee pain office or clinic?
*
Yes
No
When are you looking to get results?
*
Immediately
2 weeks
60 days
90 days and up
What type of Insurance do you have?
*
Original Medicare (red, white and blue card)
Medicare with supplimental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield
Cigna
United Healthcare Advantage
Aetna
I have insurance through my employer
other insurance / I'm not sure what plan I have
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname
*
First
Last
Email
*
Phone
*
*
I acknowledge that upon submitting this assessment I will be contacted via phone, email, or SMS by a treatment coordinator with a follow-up discussion within 24-48 hours.
x
"
*
" indicates required fields
Step
1
of
7
14%
TAKE OUR 10 SECOND QUIZ
Find Out If You Qualify for a FREE Consultation / Knee Assessment
Which Condition Are You Currently Experiencing?
*
Meniscal Tears
Osteoarthritis
Bone on bone
Knee Injury
Rate Your Daily Pain
*
1
2
3
4
5
6
7
8
9
10
Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
Yes
No
Are you currently a patient at another knee pain office or clinic?
*
Yes
No
When are you looking to get results?
*
Immediately
2 weeks
60 days
90 days and up
What type of Insurance do you have?
*
Original Medicare (red, white and blue card)
Medicare with supplimental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield
Cigna
United Healthcare Advantage
Aetna
I have insurance through my employer
other insurance / I'm not sure what plan I have
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname
*
First
Last
Email
*
Phone
*
*
I acknowledge that upon submitting this assessment I will be contacted via phone, email, or SMS by a treatment coordinator with a follow-up discussion within 24-48 hours.
x
"
*
" indicates required fields
Step
1
of
7
14%
TAKE OUR 10 SECOND QUIZ
Find Out If You Qualify for a FREE Consultation / Knee Assessment
Which Condition Are You Currently Experiencing?
*
Meniscal Tears
Osteoarthritis
Bone on bone
Knee Injury
Rate Your Daily Pain
*
1
2
3
4
5
6
7
8
9
10
Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
Yes
No
Are you currently a patient at another knee pain office or clinic?
*
Yes
No
When are you looking to get results?
*
Immediately
2 weeks
60 days
90 days and up
What type of Insurance do you have?
*
Original Medicare (red, white and blue card)
Medicare with supplimental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield
Cigna
United Healthcare Advantage
Aetna
I have insurance through my employer
other insurance / I'm not sure what plan I have
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname
*
First
Last
Email
*
Phone
*
*
I acknowledge that upon submitting this assessment I will be contacted via phone, email, or SMS by a treatment coordinator with a follow-up discussion within 24-48 hours.
x
Step
1
of
7
14%
TAKE OUR 10 SECOND QUIZ
Find Out If You Qualify for a FREE Consultation / Knee Assessment
Which Condition Are You Currently Experiencing?
*
Meniscal Tears
Osteoarthritis
Bone on bone
Knee Injury
Rate Your Daily Pain
*
1
2
3
4
5
6
7
8
9
10
Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
Yes
No
Are you currently a patient at another knee pain office or clinic?
*
Yes
No
When are you looking to get results?
*
Immediately
2 weeks
60 days
90 days and up
What type of Insurance do you have?
*
Original Medicare (red, white and blue card)
Medicare with supplimental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield
Cigna
United Healthcare Advantage
Aetna
I have insurance through my employer
other insurance / I'm not sure what plan I have
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname
*
First
Last
Email
*
Phone
*
*
I acknowledge that upon submitting this assessment I will be contacted via phone, email, or SMS by a treatment coordinator with a follow-up discussion within 24-48 hours.
x
"
*
" indicates required fields
Step
1
of
7
14%
TAKE OUR 10 SECOND QUIZ
Find Out If You Qualify for a FREE Consultation / Knee Assessment
Which Condition Are You Currently Experiencing?
*
Meniscal Tears
Osteoarthritis
Bone on bone
Knee Injury
Rate Your Daily Pain
*
1
2
3
4
5
6
7
8
9
10
Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
Yes
No
