Take this 30-second quiz to see if you qualify for a
FREE
Pain Relief Consultation.
How long have you been experiencing pain?
*
Just Recently
0-6 Months
6-12 Months
More Than 12 Months
Where are you experiencing pain?
*
Neck Pain
Back Pain
Shoulder Pain
Knee Pain
Foot Pain
Hip Pain
Other
What is this pain preventing you from doing?
*
Walking
Running
Sleeping
Exercising
Family Time
Other
What have you tried in the past to get relief?
*
Medication
Physical Therapy
Chiropractic
Physician
Googled It
Others
How old are you?
*
18-24
25-34
35-44
45-54
55-64
65 & older
What type of insurance do you have?
*
Insurance: BPA – Benefit Plan Administrators
Canada Life
Canadian Construction Workers Union
Chamber of Commerce Group Insurance
CINUP
ClaimSecure
Cowan
D.A. Townley
Desjardins Insurance
First Canadian
GMS Carrier 49
GMS Carrier 50
GroupHEALTH
GroupSource
Industrial Alliance
Johnson Inc.
Johnston Group Inc.
La Capitale Insurance and Financial Services
LiUNA Local 183
LiUNA Local 506
Other
Other Insurance?
*
Manion
Manulife Financial
OTIP (Manulife)
Maximum Benefit
People Corporation
RWAM Insurance Administrators
Sun Life Financial
TELUS AdjudiCare
Union Benefits
Equitable Life
The Co-operators
SSQ
Greenshield
Empire Life
Blue Cross
VAC (Under Blue Cross)
UV Insurance
None of the above
No Insurance
Unfortunately, we do not accept your insurance at this time, would you be interested in our cash based services?
*
Yes
No
Our staff has reserved their time for people who are serious about improving their health and wellness. Will you be able to commit to this appointment after confirming the day and time with our front desk?
*
Yes
No
What's your full name?
*
What's your email?
*
What's your phone number?
*
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