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MENS ED Wave Care
Orthopedic Conditions
Plantar Fasciitis
Achilles Tendonitis
Tennis Elbow
Golfers Elbow
Knee Osteoarthritis (OA)
Knee Tendonitis
Rotator Cuff (Shoulder) Tendonitis
Shoulder Trigger Points
High Hamstring Tendonitis
Spinal Bulging Disc
Fill out form to best diagnosis your Elbow 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.
*
Indicates required field
Do you have a budget for Wellness Care
*
Yes
No
Name
*
First
Last
Cell Phone Number
*
Text message
How do you want to be contacted?
*
Text Message
Call
Have you had Elbow Pain that
Weakens
your grip?
Grip Strength will weaken with elbow pain.
*
Yes
No
I don't recall
Do you have any Elbow pain that keeps you from activity or work?
Pain in the elbow hurts worst during activity
*
Yes
No
I don't know
How would you rate your Elbow 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 Elbow Pain?
Inside of Elbow
Outside of Elbow
Inside of the elbow
*
Yes
No
Not Sure
Outside of Elbow
*
Yes
No
Not Sure
Submit
Home
MENS ED Wave Care
Orthopedic Conditions
Plantar Fasciitis
Achilles Tendonitis
Tennis Elbow
Golfers Elbow
Knee Osteoarthritis (OA)
Knee Tendonitis
Rotator Cuff (Shoulder) Tendonitis
Shoulder Trigger Points
High Hamstring Tendonitis
Spinal Bulging Disc