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Step 1 of 7

14%

TAKE OUR 10 SECOND QUIZ
Find Out If You Qualify for a FREE Consultation / Knee Assessment
Which Condition Are You Currently Experiencing?*
- Meniscal Tears
- Osteoarthritis
- Bone on bone
- Knee Injury

Rate Your Daily Pain*
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Do You Currently Take Any Medication To Deal With Pain / Discomfort*
- Yes
- No

Are you currently a patient at another knee pain office or clinic?*
- Yes
- No

When are you looking to get results?*
- Immediately
- 2 weeks
- 60 days
- 90 days and up

What type of Insurance do you have?*
- Original Medicare (red, white and blue card)
- Medicare with secondary or supplemental insurance (Plan F, Plan G)
- Medicare Advantage Plan
- Blue Cross Blue Shield
- Aetna
- United Healthcare
- TriCare
- other insurance / I'm not sure what my plan is

Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname*
First Last
Email*
Phone*
*
- I acknowledge that upon submitting this assessment I will be contacted via phone, email, or SMS by a treatment coordinator with a follow-up discussion within 24-48 hours.

Step 1 of 7

14%

TAKE OUR 10 SECOND QUIZ
Find Out If You Qualify for a FREE Consultation / Knee Assessment
Which Condition Are You Currently Experiencing?*
- Meniscal Tears
- Osteoarthritis
- Bone on bone
- Knee Injury

Rate Your Daily Pain*
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10

Do You Currently Take Any Medication To Deal With Pain / Discomfort*
- Yes
- No

Are you currently a patient at another knee pain office or clinic?*
- Yes
- No

When are you looking to get results?*
- Immediately
- 2 weeks
- 60 days
- 90 days and up

What type of Insurance do you have?*
- Original Medicare (red, white and blue card)
- Medicare with Supplemental or secondary insurance (Plan F, Plan G)
- Blue Cross Blue Shield
- Cigna
- United Healthcare Advantage
- Aetna
- I have insurance through my employer
- other insurance / I'm not sure what plan I have

Thank you for providing this case information. Please complete the form below to send these assessment results to our team:
Name / Surname*
First Last
Email*
Phone*
*
- I acknowledge that upon submitting this assessment I will be contacted via phone, email, or SMS by a treatment coordinator with a follow-up discussion within 24-48 hours.

Find Out if You Qualify by Filling Out This Quick Questionnaire.

"*" indicates required fields

Step 1 of 3

33%

Current Condition*

Which Knee Are Having Pain?*

Left

Right

Both

Rate Your Daily Pain*

Do You Take Pain Medication Daily?*

Yes

No

Have You Had Any Knee Surgeries?*

Yes

No

Have You Been Told You Need Knee Surgery?*

Yes

No

Do You Have Medicare Insurance?*

Yes

No

First Name*

Last Name*

Phone*

Email*

Name

This field is for validation purposes and should be left unchanged.