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Meniscal Tears
Osteoarthritis
Bone on bone
Knee Injury
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*
1
2
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7
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Are you currently a patient at another knee pain office or clinic?
*
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Step
1
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TAKE OUR 10 SECOND QUIZ
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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)
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commercial PPO insurance (Blue Cross, Aetna, Cigna, United Healthcare, TriCare, or another insurance)
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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
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Aetna
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Meniscal Tears
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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)
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Aetna
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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)
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Aetna
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TAKE OUR 10 SECOND QUIZ
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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
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Aetna
I have insurance through my employer
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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
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Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
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7
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TAKE OUR 10 SECOND QUIZ
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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
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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)
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Aetna
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Knee Injury
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*
1
2
3
4
5
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7
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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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)
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Aetna
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*
1
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3
4
5
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
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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)
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Humana
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*
1
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3
4
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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*
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When are you looking to get results?
*
Immediately
2 weeks
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90 days and up
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Original Medicare (red, white and blue card)
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Tricare
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Knee Injury
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*
1
2
3
4
5
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7
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10
Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
Yes
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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
Tricare
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Knee Injury
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*
1
2
3
4
5
6
7
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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*
Yes
No
When are you looking to get results?
*
Immediately
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Knee Injury
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*
1
2
3
4
5
6
7
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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
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90 days and up
What type of Insurance do you have?
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Original Medicare (red, white, and blue card)
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Cigna
Care Source / Buckeye Insurance
Molina
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Knee Injury
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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
*
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)
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Aetna
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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)
Aetna
Blue Cross Blue Shield
Cigna
Humana
Tricare
United Health Care
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Step
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7
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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?
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Chronic Knee Pain
Tearing
Stiffness
Joint Degeneration
Throbbing, Aching Knee Joints
Proven Results from a Trusted Team
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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 supplemental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield
United Healthcare
United Healthcare AARP
Cigna
Humana
Aetna
other insurance / I'm not sure what my plan is
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*
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Knee Injury
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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
*
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 supplemental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield
United Healthcare
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Humana
Aetna
other insurance / I'm not sure what my plan is
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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 supplemental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield
United Healthcare
United Healthcare AARP
Cigna
Humana
Aetna
other insurance / I'm not sure what my plan is
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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 supplemental or secondary insurance (Plan F, Plan G)
Medicare Advantage Plan
Humana
Aetna
Blue Cross
other insurance / I'm not sure what insurance I have
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Step
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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 secondary or supplemental insurance (Plan F, Plan G)
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Horizon
UHC / Oxford PPO
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1
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Yes
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Immediately
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1
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3
4
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7
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Immediately
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1
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4
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Yes
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Immediately
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1
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3
4
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Yes
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1
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3
4
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Yes
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Yes
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When are you looking to get results?
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Immediately
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1
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3
4
5
6
7
8
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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
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3
4
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Yes
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Are you currently a patient at another knee pain office or clinic?
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Yes
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When are you looking to get results?
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4
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7
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Yes
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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4
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4
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When are you looking to get results?
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Immediately
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Are you currently a patient at another knee pain office or clinic?
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When are you looking to get results?
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Immediately
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1
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3
4
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7
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Yes
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1
2
3
4
5
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
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Yes
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Are you currently a patient at another knee pain office or clinic?
*
Yes
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When are you looking to get results?
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Immediately
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1
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3
4
5
6
7
8
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Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
Yes
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Are you currently a patient at another knee pain office or clinic?
*
Yes
No
When are you looking to get results?
*
Immediately
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What type of Insurance do you have?
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1
2
3
4
5
6
7
8
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10
Do You Currently Take Any Medication To Deal With Pain / Discomfort
*
Yes
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Are you currently a patient at another knee pain office or clinic?
*
Yes
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Immediately
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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 supplemental insurance
Medicare with secondary insurance
Medicare Advantage Plan (Medicare as secondary insurance)
Aetna
Blue Cross Blue Shield
Cigna
Humana
Tricare
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*
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*
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*
When would you prefer to be contacted?
*
11 AM - 1 PM
1 PM- 3 PM
3 PM - 5 PM
5 PM - 6 PM
*
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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*
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 plus supplemental insurance
Medicare plus secondary insurance
Aetna
AvMed
Blue Cross Blue Shield
Cigna
GEHE
Humana
Humana Choice
United Healthcare
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*
*
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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 supplemental coverage
Medicare with secondary coverage
Blue Cross Blue Shield
Cigna
other insurance
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*
*
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*
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 Supplemental Insurance
Medicare
United Healthcare AARP
Blue Cross Blue Shield
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*
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Meniscal Tears
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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)
Traditional Medicaid (disability)
Medicare Advantage Plan (Medicare through a commercial provider)
Peachstate (Medicaid)
Ambetter
Wellcare (Medicare + Medicaid)
Blue Cross Blue Shield, Anthem
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*
*
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Meniscal Tears
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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?
*
Traditional Medicare
Medicare plus Secondary Insurance
Medicare plus Supplemental Insurance
Aetna
United Healthcare
United Healthcare AARP
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Blue Cross Blue Shield
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*
*
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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 supplemental insurance
Medicare with secondary insurance
Medicare Advantage Plan
Please note that we are ONLY in-network with original Medicare (red, white, and blue card). We are not in-network with any commercial insurances such as Blue Cross, Aetna, Cigna, United Healthcare, or any other commercial insurance plans.
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*
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*
*
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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 supplemental insurance
Medicare with secondary insurance
other insurance / I'm not sure
**Please note that our office is currently ONLY in-network with traditional Medicare (red, white, and blue card).
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
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*
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*
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*
*
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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*
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?
*
Medicare
BlueCross BlueShield
Aetna
Cigna
Hap
Humana
Tricare
Others
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*
*
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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 supplemental coverage
Medicare with secondary coverage
Blue Cross Blue Shield
Cigna
other insurance
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
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*
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*
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*
*
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*
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?
*
United Healthcare
Aetna
Humana
Blue Cross Blue Shield
Medicare
Medicare Advantage Plans
Medicaid
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*
*
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*
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 plus supplemental insurance
Medicare plus secondary insurance
Aetna
AvMed
Blue Cross Blue Shield
Cigna
GEHE
Humana
Humana Choice
United Healthcare
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
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*
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*
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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*
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)
Regence
Cigna
Aetna
Humana
DMBA
UMR
Select Health (we DO NOT accept Select Health Advantage Plans)
Medicare Advantage Plan through Regence, Cigna, Aetna, Humana
Select Advantage
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*
*
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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)
Medicare with Supplemental or Secondary Coverage (Plan F, Plan G)
Medicare Advantage Plan
United Healthcare
Cigna
Aetna
other insurance
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*
*
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*
Hip Pain
Shoulder Pain
Elbow Pain
Pain and other Joints
Rate Your Daily Joint Pain from 1-10
*
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 seeking any surgical or non-surgical care for joint pain?
*
Yes
No
When are you looking to get results?
*
Immediately
2 weeks
60 days
90 days and up
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
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*
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*
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*
*
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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*
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?
*
Federal Medicare
Humana Medicare
Aetna Medicare
Blue Cross Blue Shield
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*
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*
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After 5 PM
*
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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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 supplemental or secondary insurance (Plan F, Plan G)
Blue Cross Blue Shield (of New Hampshire or Massachusetts)
United Healthcare
Cigna
Humana
Tricare
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*
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*
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*
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Between 2 PM and 5 PM
After 5 PM
*
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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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?
*
Federal Medicare part B
Blue Cross Blue Shield
Anthem Blue Cross Blue Shield
Carefirst
Aetna
Priority Partners
Johns Hopkins Community Plan
Cigna
Coventry
AARP
United Health Care
Tricare for Life
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*
*
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Meniscal Tears
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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 Advantage Plan
Humana
Humana Gold HMO
United Healthcare / AARP
Wellcare
RR Medicare
Blue Cross Blue Shield
Anthem
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*
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*
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*
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Between 2 PM and 5 PM
After 5 PM
*
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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*
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 supplemental or secondary insurance (Plan F, Plan G)
Medicare Advantage Plan
Cigna
United Healthcare
Blue Cross Blue Sheild
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*
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*
Before Noon
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Between 2 PM and 5 PM
After 5 PM
*
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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*
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 supplemental insurance
Medicare with secondary insurance
Medicare Advantage Plan (Medicare as secondary insurance)
Aetna
Blue Cross Blue Shield
Cigna
Humana
Tricare
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*
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*
*
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*
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 supplemental insurance
Medicare with secondary insurance
Aetna
Other commercial insurances
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
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*
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*
*
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Step
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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?
*
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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
*
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
Medicare w/ secondary insurance
Medicare w/ Supplemental Insurance
Blue Cross Blue Shield
Aetna
Cigna
Humana
United Healthcare
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*
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Knee Injury
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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
*
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
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*
Original Medicare
Medicare plus Supplemental Insurance
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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
*
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?
*
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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?
*
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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?
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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
*
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
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Knee Injury
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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
*
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
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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?
*
Traditional Medicare
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Aetna
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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?
*
Traditional Medicare
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Ambetter
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Knee Injury
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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
*
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?
*
Traditional Medicare
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United Healthcare
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Blue Cross Blue Shield
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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?
*
Traditional Medicare
Medicare plus Supplement
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Knee Injury
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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
*
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
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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
*
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
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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
*
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
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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
*
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
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Ulcers
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*
Yes
No
On a scale of 1-10, please rate your daily pain:
*
1
2
3
4
5
6
7
8
9
10
How long have you been experiencing chronic foot wounds caused by diabetes?
*
Less than 1 year
More than 1 year
More than 5-10 years
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This treatment is only covered by Federal Medicare; are you currently a Federal Medicare patient?
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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
*
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
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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
*
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?
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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
*
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
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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
*
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
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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
*
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
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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
*
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
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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
*
Yes
No
Are you currently a patient at another knee pain office or clinic?
*
Yes
No
When are you looking to get results?
*
Immediately
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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?
*
Federal Medicare
Federal Medicare with Supplementary Insurance
Medicare Advantage Plans
Aetna
Aetna ESA
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.
×
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?
*
United Healthcare
Aetna
Humana
Blue Cross Blue Shield
Medicare
Medicare Advantage Plans
Medicaid
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname
*
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Last
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*
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.
×
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?
*
Federal Medicare
Federal Medicare with Secondary Coverage
Medicare Advantage Plans
United HealthCare
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.
×
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?
*
Blue Cross Blue Shield
United Health Care
UHC / AARP
Federal Medicare
Federal Medicare with secondary coverage
No Insurance / I am a cash patient
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
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*
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.
×
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?
*
BlueCross BlueShield
United HealthCare
Medicare
Others
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.
×
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?
*
Traditional Medicare
Medicare + Supplemental Insurance
Medicare + Secondary Insurance
Aetna
Blue Cross Blue Shield
I don't have insurance / I am a cash patient
WellCare
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Name / Surname
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Last
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*
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*
*
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.
×
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?
*
Medicare
BlueCross BlueShield
Aetna
Cigna
United HealthCare
Others
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname
*
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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.
×
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?
*
Medicare
BlueCross BlueShield
Aetna
Cigna
United HealthCare
Others
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.
×
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?
*
Medicare
BlueCross BlueShield
Aetna
Cigna
Hap
Humana
Tricare
Others
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname
*
First
Last
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*
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.
×
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?
*
Medicare
BlueCross BlueShield
Aetna
Cigna
Hap
Humana
Tricare
Others
Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname
*
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Last
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*
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.
×
Step 1 of 2: Please fill out the form below ....
Select below the session you would like to attend:
*
Wednesday, November 13th at 6:45 PM @ Double Tree by HIlton, Bloomfield Hills 39475 Woodward Ave, Bloomfield Hills, MI 48304
Topic: Non-Surgical Joint Pain Relief
*
Topic: Non-Surgical Joint Pain Relief
Please enter your information below for event verification:
First and Last Name
*
Email Address
*
Mobile Number
*
Guest Name
*
Please tell us how we can help you:
What Condition / Symptoms Are You Currently Experiencing?
How Is This Condition / Symptoms Affecting Your Daily Life?
When Are You Looking To Get Results?
When would you like us to call you to confirm?
*
9:00AM-Noon (EST)
Noon-2PM (EST)
2PM-5PM (EST)
As soon as possible
*
I acknowledge that all the information above is correct and upon submitting this form a patient coordinator from the clinic may call for follow up questions.
×
Step 1 of 2: Please fill out the form below ....
Select below the session you would like to attend:
*
Tuesday, November 19th at 6:30 PM @ Nulife Medical, 31333 Southfield Road, Suite 130 Beverly Hills, MI 48025
Topic: Non-Surgical Knee Pain Relief
*
Topic: Non-Surgical Knee Pain Relief
Please enter your information below for event verification:
First and Last Name
*
Email Address
*
Mobile Number
*
Guest Name
*
Please tell us how we can help you:
What Condition / Symptoms Are You Currently Experiencing?
How Is This Condition / Symptoms Affecting Your Daily Life?
When Are You Looking To Get Results?
When would you like us to call you to confirm?
*
9:00AM-Noon (EST)
Noon-2PM (EST)
2PM-5PM (EST)
As soon as possible
*
I acknowledge that all the information above is correct and upon submitting this form a patient coordinator from the clinic may call for follow up questions.
×
Step 1 of 2: Please fill out the form below ....
Select below the session you would like to attend:
*
Thursday, November 7th at 6:30 PM @ Nulife Medical, 31333 Southfield Road, Suite 130 Beverly Hills, MI 48025
Topic: Non-Surgical Knee Pain Relief
*
Topic: Non-Surgical Knee Pain Relief
Please enter your information below for event verification:
First and Last Name
*
Email Address
*
Mobile Number
*
Guest Name
*
Please tell us how we can help you:
What Condition / Symptoms Are You Currently Experiencing?
How Is This Condition / Symptoms Affecting Your Daily Life?
When Are You Looking To Get Results?
When would you like us to call you to confirm?
*
9:00AM-Noon (EST)
Noon-2PM (EST)
2PM-5PM (EST)
As soon as possible
*
I acknowledge that all the information above is correct and upon submitting this form a patient coordinator from the clinic may call for follow up questions.
×
Step 1 of 2: Please fill out the form below ....
Select below the session you would like to attend:
*
Thursday, November 14th at 6:30 PM @ Nulife Medical, 31333 Southfield Road, Suite 130 Beverly Hills, MI 48025
Topic: Non-Surgical Knee Pain Relief
*
Topic: Non-Surgical Knee Pain Relief
Please enter your information below for event verification:
First and Last Name
*
Email Address
*
Mobile Number
*
Guest Name
*
Please tell us how we can help you:
What Condition / Symptoms Are You Currently Experiencing?
How Is This Condition / Symptoms Affecting Your Daily Life?
When Are You Looking To Get Results?
When would you like us to call you to confirm?
*
9:00AM-Noon (EST)
Noon-2PM (EST)
2PM-5PM (EST)
As soon as possible
*
I acknowledge that all the information above is correct and upon submitting this form a patient coordinator from the clinic may call for follow up questions.
×
×
×
Step
1
of
6
16%
Current Condition
*
Osteoarthritis
Knee Injury
Bone on Bone
I'm Not Sure
Which Knee Are You Having Pain?
*
Left
Right
Both
Rate Your Daily Knee Pain
*
1-3 (Mild Pain)
4-7 (Moderate Pain)
8-10 (Extreme Pain)
Have You Had Knee Surgery Previously?
*
No
Yes
Do You Take Pain Medicine Daily?
*
Yes
No
Do You have Medicare Insurance?
*
No
Yes
Have You Been Told You Need Knee Surgery?
*
Yes
No
First Name
*
Last Name
*
Phone #
*
Email
*
