Next Step: Complete This Intake Form Now!

Tell Us More About Your Condition

Complete This 30-second survey to reserve your voucher

What is the source of your pain? *

Neck

Mid Back

Lower Back

Have you been diagnosed with any of the following? (Please check all that apply.) *

Sciatica

Herniated or bulging disc

Spinal stenosis

Degenerative disc disease

Previous neck or back surgery

None of these diagnosis

How long have you been dealing with your symptoms for? *

Less than 1 year

1-3 years

3-5 years

5-10 years

10+ years

Have you had any MRI or X-Ray taken in the last 2 years? *

Yes

Are there any screws or rods in your spine? *

Yes

On a scale of 1-5, where 5 is the highest, how excruciating are your symptoms? *

5 - Excruciating: Unbearable intensity, completely disrupts normal activity.

4 - Severe: Intense stress, significantly hinders activities.

3 - Uncomfortable: Persistent discomfort affects daily life.

2 - Moderate: Some daily disruption.

1 - Mild: Slightly stress, minimal impact.

On a scale of 1-5, where 5 is the highest, how would you rate your commitment to taking care of your pain right now? *

5 - All-In: Fully committed to a comprehensive, intensive approach.

4 - Eager: Strongly ready for active, significant measures.

3 - Ready: Willing for regular efforts and moderate changes.

2 - Hesitant: Some openness, but mostly reluctant to extensive actions.

1 - Resistant: Only open to minimal efforts, largely unwilling.

Assuming we can help you, treatments typically aren't fully covered by insurance. If there was a low monthly payment to get the help that you needed, is that something that could possibly work for you? *

Yes

Maybe

Financing options are available based on your credit. Which option best describes your credit? *

Excellent Credit (Above 750)

Great Credit (700-750)

Average Credit (650-700)

Poor Credit (Below 580-650)

Bad Credit (Below 580)

Please re-verify your Full Name. *

Please re-verify your Phone Number. *

Only 7 Vouchers Are Remaining

Appointments are given on a first-come, first-served basis due to minimal availability. Book as soon as possible to lock in your appointment.

Citrus Ridge Health Center

863-334-2551

115 Lake Davenport Blvd Davenport, FL 33897

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**Appointments are given on a first-come, first-served basis due to minimal availability. Book as soon as possible to lock in your appointment. **

Citrus Ridge Health Center

863-334-2551

Appointments are given on a first-come, first-served basis due to minimal availability. Book as soon as possible to lock in your appointment.