Joint & Spine Health Survery

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Take the Survey: Joint & Spine Health

Completing this survey in full will automatically enter you into the contest for a chance to win a Health Supplement Bundle & a $50 Whole Foods Gift Card! Results will be emailed.

12Questions

1
On a daily basis, do you sit...* This field is required.
More than 10 hours a day
around 8 hours a day
around 5 hours a day
4 hours or less
2
How often do you exercise in a week?* This field is required.
7 or more times per week
5-7 times per week
3-5 times per week
1-3 times per week
0 times per week
3
What kind of physical activities do you regularly participate in?* This field is required.Please select ALL that APPLY
Walking
Running
HIIT (High Intensity Interval Training)
CrossFit
Yoga or Pilates
Stretching
Sports Games
Dance
Heavy Weight Training
Group Exercise Classes
4
On a MONTHLY Basis do you experience any...* This field is required.Please Select ALL that Apply
Muscle Pain or Soreness
Neck Pain or Tightness
Lower Back Pain
Middle Back Pain
Pain around the shoulder blades
Knee Pain or Stiffness
Hip Pain or Stiffness
Lack of Mobility
Migraines
Hunching Over while Sitting
Sciatica Pain - down the back, buttocks and back or side of legs
Pain or Stiffness when moving from sitting to standing position
Pain or Stiffness when waking up in the morning
Pain or injury when working out/exercising
The inability to stand for long periods of time
5
On a WEEKLY Basis do you experience any...* This field is required.Please Select ALL that Apply
Muscle Pain or Soreness
Neck Pain or Tightness
Lower Back Pain
Middle Back Pain
Pain around the shoulder blades
Knee Pain or Stiffness
Hip Pain or Stiffness
Lack of Mobility
Migraines
Hunching Over while Sitting
Sciatica Pain - down the back, buttocks and back or side of legs
Pain or Stiffness when moving from sitting to standing position
Pain or Stiffness when waking up in the morning
Pain or injury when working out/exercising
The inability to stand for long periods of time
6
Have you been diagnosed or think you may have any of the following conditions?* This field is required.Select ALL that Apply
Scoliosis
Spinal Cord Injury
Arthritis
Osetoarthritis
Neuropathy
Chronic Migraines
Carpal Tunnel
Chronic Abdominal Pain
Chronic Muscle Spasms or Tightness
Chronic Sciatica
Spinal Stenosis
Cancer
Hernia/Hernia Repair Pain
Chronic Back Pain
7
Do you currently take any natural health supplements for joint health, immunity, bone health, or inflammation?* This field is required.Insurance coverage
Yes
No
8
Would you be interested in a evaluative consultation for pain related conditions and overall wellness?* This field is required.Insurance coverage
Yes
No
9
Your Full Name* This field is required.
First Name
Last Name
10
Your Cell Phone Number* This field is required.
Please enter a valid phone number.
11
Your Email* This field is required.For winner announcement and educational health content
example@example.com
12
Your Zip Code* This field is required.
Should be Empty:

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