Take this 30-second quiz to see if you qualify for a
FREE
Pain Relief Session.
How long have you been experiencing pain?
*
Just Recently
0-6 Months
6-12 Months
More Than 12 Months
Where are you experiencing pain?
*
How old are you?
*
18-24
25-49
50-64
65 & older
What type of insurance do you have?
*
Medicare
Workers Comp
Blue Cross Blue Shield
Aetna
United Health Care
Nyship
No Insurance
Other
Other Insurance?
*
Empire Plan
Oxford
No Fault
Magnacare
None of the above
What's your full name?
*
What's your best email?
*
What's your best phone number?
*
