Name *
Do you have neck and/or back pain for longer than 20 minutes per day?
Do you get more than one headache per week?
Do you take over-the-counter pain medications like ibuprofen or acetaminophen more than once a week?
Have you been in a motor vehicle accident over 35 mph or incurring $4,000+ amount of damage to your car or vehicle?
Are you younger than 40 and experience chronic back pain more than twice a week?