To be able to help you to my best ability, please can you tell me more about your pain and in as much detail as possible.

First Name

Last Name

Email Address

Phone Number

What is your primary complaint? Where is it located? Intensity? How often? Any patterns? Possible triggers? When is it worst? Etc

On a scale of 1 to 10 how would you rate the pain currently?

What does it stop you from doing?

How does it make you feel?

Who/ what have you tried in the past to help with this problem? E.g. Massage, Physiotherapy, Chiropractor, Stretching, Personal Trainer, Foam Rolling, Acupuncture, Injections, Medication, Surgery, etc

What were the results of the above approaches?

If you had a magic wand, what would your dream outcome be?

What outcome at a MINIMUM would make your life better? E.g. An improvement from 7/ 10 pain down to 2/10 and knowing what to do to keep it at bay.

Do you have a time frame/ deadline for this to be accomplished by? E.g. Upcoming competition/ sporting event. Special occasion- holiday, wedding, graduation, birthday, etc. Strict schedule due to work commitments

Hoe did you find out about Pain Free Ninja? Hoe did you find out about Pain Free Ninja? Website Networking Event Word of Mouth Social Media Other

Terms and Conditions Terms and Conditions I confirm I have read the Terms and Conditions Terms and Conditions