Please indicate the nature of your injury or reason for your appointment

    • [[{"field_id":23886,"subrules":{"field_id":23891,"value":"Shoulder","operator":"Match"}}],[{"field_id":23886,"subrules":{"field_id":23891,"value":"Elbow","operator":"Match"}}],[{"field_id":23886,"subrules":{"field_id":23891,"value":"Wrist","operator":"Match"}}],[{"field_id":23886,"subrules":{"field_id":23891,"value":"Hand","operator":"Match"}}],[{"field_id":27129,"subrules":{"field_id":23891,"value":"Hip","operator":"Match"}}],[{"field_id":23886,"subrules":{"field_id":23891,"value":"Knee","operator":"Match"}}],[{"field_id":23886,"subrules":{"field_id":23891,"value":"Ankle","operator":"Match"}}],[{"field_id":23886,"subrules":{"field_id":23891,"value":"Low back","operator":"Match"}}],[{"field_id":23886,"subrules":{"field_id":23891,"value":"Mid back","operator":"Match"}}],[{"field_id":23886,"subrules":{"field_id":23891,"value":"Neck\/Upper back","operator":"Match"}}]]

Choose the reason for your visit 

    • [[{"field_id":23882,"subrules":{"field_id":23886,"value":"New Patient","operator":"Match"}}],[{"field_id":23882,"subrules":{"field_id":23886,"value":"Recheck","operator":"Match"}}]]

What type of appointment would you like to schedule?

[[{"field_id":23883,"subrules":{"field_id":23882,"value":"Injury","operator":"Match"}}],[{"field_id":23890,"subrules":{"field_id":23882,"value":"Chronic Pain","operator":"Match"}}]]

Choose the reason for your visit 

    • [[{"field_id":27130,"subrules":{"field_id":27129,"value":"New Patient","operator":"Match"}}],[{"field_id":27130,"subrules":{"field_id":27129,"value":"Recheck","operator":"Match"}}]]

What type of appointment would you like to schedule?

[[{"field_id":23883,"subrules":{"field_id":27130,"value":"Injury","operator":"Match"}}],[{"field_id":23890,"subrules":{"field_id":27130,"value":"Chronic Pain","operator":"Match"}}]]

Does any of the following pertain to your injury?

    • [[{"field_id":23890,"subrules":{"field_id":23883,"value":"None","operator":"Match"}}]]

Are you using insurance for this visit?

    • [[{"field_id":23884,"subrules":{"field_id":23890,"value":"Yes","operator":"Match"}}],[{"field_id":23885,"subrules":{"field_id":23890,"value":"No","operator":"Match"}}]]

Please select your preferred insurance for this visit.

    • [[{"field_id":23885,"subrules":{"field_id":23884,"value":"My Insurance Is Not Listed\n","operator":"Match"}}]]

Have you been diagnosed with or suspected of having a fracture?