Step 1 of 8
Knee Pain Protocol Survey
Before we begin, please provide your contact information. 

If you are a good candidate for our knee pain protocols, someone from our team will contact you within one business day.

Step 2 of 8
Knee Pain Protocol Survey
What activities cause you to experience knee pain?  

Please select all that apply.

Step 3 of 8
Knee Pain Protocol Survey
Duration of Condition:
How long have you been experiencing your symptoms?
Step 4 of 8
Knee Pain Protocol Survey
Severity of Condition:
On a scale of 1-10, how would you rate the severity of your symptoms?
Step 5 of 8
Knee Pain Protocol Survey
Previous Treatments:
What have you done in the past to treat your knee pain?

Please select all that apply.

Step 6 of 8
Knee Pain Protocol Survey
On a Scale of 1 – 10 with 1 being the lowest level of success and 10 being the highest, How well have you been able to manage your symptoms with your past treatments?
Step 7 of 8
Knee Pain Protocol Survey
Treatment Goals and Expectations:
What are your primary goals and expectations from a treatment for knee pain?  

Please select all that apply.

Step 8 of 8
Knee Pain Protocol Survey
Comments and concerns:
Is there any additional information you would like to share with the Doctor before we contact you?  
Thanks! We have received your form submission. Someone from our team will reach out to you shortly.
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