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Muscle & Joint Shock Wave
Heel Pain
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Heel Pain
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Diagnosis Your Knee Pain
Knee Pain
Hip Pain
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Low Back Pain
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Diagnosis Your Shoulder Pain
Shoulder Pain
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Diagnosis Your Elbow Pain
Elbow Pain
Ankle Pain
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Diagnosis Your Ankle Pain
Ankle Pain
Fill out form to best diagnosis your Ankle Pain
Health Insurance will not cover Muscle & Joint Wave Care.
Patients will pay out of pocket for Wave Care, by using Health Savings/ FSA,
debt card, Cash and credit card.
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Do you have a budget for Wellness Care
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No
Name
*
First
Last
Cell Phone Number
*
Text message
How do you want to be contacted?
*
Text Message
Call
Have you had Ankle Pain that
Weakens
you when you walk or run?
Due to ankle twisting and instability you can't walk or play due to pain
*
Yes
No
I don't recall
Do you have any ankle pain that keeps you from activity or work?
Pain in the ankle hurts worst during activity
*
Yes
No
I don't know
How would you rate your Ankle pain?
How would you rate your pain?
*
1-3
3-4
5-6
7-8
8-9
10
Prefer not to say
Where do you feel Ankle Pain?
Outside of Ankle
Inside of Ankle
Inside of the Ankle
*
Yes
No
Not Sure
Outside of Ankle
*
Yes
No
Not Sure
Submit
Home
Men's E.D. Care
Men's Erectile Dysfunction Score
Learn about E.D. Wave Care
Muscle & Joint Shock Wave
Heel Pain
>
Heel Pain
Diagnosis Your Heel Pain
Knee Pain
>
Diagnosis Your Knee Pain
Knee Pain
Hip Pain
Low Back Pain
>
Diagnosis Your Back Pain
Low Back Pain
Shoulder Pain
>
Diagnosis Your Shoulder Pain
Shoulder Pain
Elbow Pain
>
Diagnosis Your Elbow Pain
Elbow Pain
Ankle Pain
>
Diagnosis Your Ankle Pain
Ankle Pain
