GOT QUESTION? TEXT MESSAGE TO 801-987-0335
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
Wrist Pain
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
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
Wrist Pain
