EMPLOYEE Session

Company Staff Schedule Your Appointment Here

PERSONAL DETAILS
Name
Email Address
Phone Number
Age
Gender
Occupation
PAIN QUESTIONNAIRE
Are you being seen for health or pain coaching?
Medical History:
Surgical history?
If pain coaching, did you have a trauma or injury?
What body part are we addressing today?
If health coaching, what health behavior would you like to discuss?
By clicking the above I confirm that I have read and accept all terms and conditions set forth in this waiver.
Enter Company Name
Select Consult Type:
Appointment Type:
Preferred Communication:
CHOOSE DATE AND TIME:
Calendar In Eastern Day Time (EDT)

DISCLAIMER

This telehealth service is provided by licensed physical therapists to provide advice as to potential treatment options for musculoskeletal pain that is affecting your activities of daily living. Examples of musculoskeletal pain include lower back pain and pain in your joints.

While we can suggest treatment, we cannot guarantee any particular course of treatment will be successful.

A telehealth consult with a licensed physical therapist is not a substitute for an in-person physical examination by a licensed physical therapist or physician. Chronic or severe pain may be indicative of a larger health issue that can only be diagnosed and treated by a licensed physician. If you are having a medical emergency, please dial 911 or go to the nearest hospital emergency room.

This service is provided for adult consumers over the age of 18. If you are under the ageof 18, it is unlawful for you to use this service without parental consent.

Navigate Pain, LLC, disclaims all warranties with regard to the telehealth services provided. In no event shall Navigate Pain, LLC, or any shareholders, members or employees, be liable for any damages whatsoever including but not limited to special, indirect or consequential damages resulting from personal injuries, medical expenses or loss of income arising out of the use of this service or any of the information provided through this telehealth service.

I give my consent to Navigate Pain and its affiliates to both collect private health information and provide counsel and offer recommendations about managing my musculoskeletal pain and best course of action to take regarding my symptoms. I acknowledge that no guarantees have been made to me as to the effect of such examinations or counsel on the condition and I am responsible for all charges in connection with advice treatment rendered.