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Search for:
Home
About DPT
Meet Dr. Tom
About Dr. Tyler
About Dr. Taylor
Testimonials
Physical Therapy
Sciatica
Knee Pain
Back Pain
Extracorporeal Magnetotransduction Therapy (EMTT)
Extracorporeal Pulse Activation Technology (EPAT) Shockwave
Hip Pain
Neck Pain
Shoulder Pain
Running And Sport
Running Analysis
Pain With Running
Telehealth
Massage Therapy
Resources
Blog
Podcast
Hiring
Hiring Client Care Coordinator
Physical Therapist
Marketing Assistant
Hiring Operations Manager
Contact
Contact Us
Inquire About Cost And Availability
Discovery Visit
Free Phone Consultation
Neck Workshop Lesa’s Reg Form
thedoctorsofpt
2022-02-09T18:30:51+00:00
Neck Pain Workshop Registration
First Name *
Last Name *
Email *
Street Address 1 *
City *
State *
Postal Code *
How did they hear about the workshop? *
Phone 1 *
What seems to be the problem? *
How long have you suffered or worried *
Haven't - this is prevention (not cure)
A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Seems Like Too Long (years)
Other concerns (specific) *
What does it stop you from doing? *
Appointment Booked By *
Lesa
Dr. Tom
Dr. Stephanie
Elijah
P.S Section *
What they'd like to hear about at the WS *
Favorite beverage?
If they haven't tried PT before, why not? *
If we could prove PT could help, would you be willing to try it? *
What Is The Main Goal You Would Like Us To Help You Achieve? *
Please select one
Avoid Painkillers Or Surgery
Find Out What's Wrong
Get Active
Stay Active
Other
Submit
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