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Consult With Kobra

First Name

Email address

What's your age and sex?

Enter today's date

Where is the pain located?

When did these issues start?

How did this injury happen?

Describe your pain

Describe your pain
A
B
C
D
E
F

Have you seen anyone for this injury? Did it help?

What treatments have you had for it? (meds, injection, PT, chiro)

What movements or activities have you had to stop because of your pain/injury?

What movements or activities DECREASE your pain?

What imaging have you had, if any? (X-ray, MRI, CT)

What activities do you need/want to return to that you cannot do now?

Give me the current details of your current training/workout program. Is there anything specific you are training for?

What can I do for you today that will help you the most?

How did you hear about us?

Are you over the age of 18? If not, please provide your guardian's email below. Please note we will not have any virtual calls with you without a legal adult present.

Are you over the age of 18? If not, please provide your guardian's email below. Please note we will not have any virtual calls with you without a legal adult present.

Guardian email

So there are no surprises, check "I acknowledge" since the assumption is you've made it this far and you want to work with us. As much as we LOVE to chat to people about injuries, we do have bills to pay. We will review the info you provided and determine if our products and services are the right solution for you. If we don't think we are the right fit, we can help refer you to someone else in our network.

So there are no surprises, check "I acknowledge" since the assumption is you've made it this far and you want to work with us. As much as we LOVE to chat to people about injuries, we do have bills to pay. We will review the info you provided and determine if our products and services are the right solution for you. If we don't think we are the right fit, we can help refer you to someone else in our network.