Painless Trigger Point Therapy
Evaluation Form

Name      E-Mail     
Phone     Profession  Age    
 
Describe your condition, the treatment you'd like, and your desired results.
discomfort location rotator cuff low back at sacrum side of waist mid-back/lower ribs side of upper glut mid glut hamstring I T band calf ankle heel of foot arch arch of foot ball of foot upper neck side of neck neck at shoulder between shouder blades      sensation muscle tightness discomfort ocassional pain restricted motion chronic pain pain after activity      possible cause job related time at computer accident bad posture pre-existing surgery overuse sports injury    # of years 1 to 11 mths 1 to 5 yrs 6 to 10 yrs 11 to 20 yrs 20 to 35 yrs

Type here
The way I feel now.... The improvement I would like to experience ....

If so, how soon did you require treatment: