272 HERITAGE PARK DRIVE, MURFREESBORO, TENNESSEE, 37129 USA

Home
TREATMENT SERVICES
YOUR TEAM
NEW PATIENTS
- NEW PATIENT APPLICATION
- AUTO ACCIDENT
HELPFUL INFO
Español

WELCOME NEW PATIENTS

Efficient and Easy Onboarding

Prior to paying for an appointment please complete the short survey below and we will tell you if you would be a potential candidate for one of our programs.

This survey is provided at zero cost to you.

New Patient Survey

Please fill out the survey below to help us understand your needs.

Our team will review your information and get back to you promptly with our recommendations.

Ready to start your journey to better health? Complete the survey and let us help you take the first step.

First Name *

Last Name *

Email *

Phone *

🔒 Your information will never be shared with third parties and we promise to never spam you.

By clicking SUBMIT, you agree that your information may be used to contact you.

Where is the source of your pain? Choose all options that apply. *

Headache

Neck

Back

Shoulder

Arms

Knee

Legs

Other

On a scale of 1-5, one being hardly any pain and five being unbearable, how would you rate your pain? *

1

2

3

4

5

How did the pain begin? Choose all options that apply. *

Accident at home

Vehicle accident

Accident at work/work related

It just began

After surgery

Came on gradually

Sports related

Other

How long have you been dealing with the pain or discomfort?

Less than 1 year

3-5 years

5-10 years

10+ years

Have you had any surgeries to your existing pain or any other pain condition?

Yes

No

How committed are you to fixing your pain TODAY?

Very committed
Not ready to commit yet
No elements found. Consider changing the search query.
List is empty.

NEXT

©2024 by TheDiscDoctor

All Rights Reserved | Privacy Policy