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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 Low back Pain
Do you have a Budget for out of pocket health care costs or Wellness Care?
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Do you have a budget for Wellness Care
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Name
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Last
Cell Phone Number
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How do you want to be contacted?
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Have you had trauma to your Back?
Have you had trauma by falling, twisting or injury to Back
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Yes
No
I don't recall
Do you have any pain down the leg or numbness tingling in foot?
Pain in the back can create traveling pain down the leg
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No
I don't know
How would you rate your Back pain?
How would you rate your pain?
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8-9
10
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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