& SEEING PATIENTS
Are you experiencing pain or discomfort in any of the following areas? (Chief Complaint)
TMJ (Lock Jaw)
Radiating Disc Problem or Pain
Are you interested in any of the following areas of wellness?
Skin Care/ Anti Aging Products
All information in this survey is confidential and will not be sold to third parties. Please note that filling out this survey, you understand that you are willingly participating in our event and that your employer bears no responsibility for any pain or injuries sustained from this event. Your name and Last Name Initial serves as e-Signature.
Thanks for Participating!