1410 W Broadway St, Ste 105, Oviedo 32765

This quick ONE MINUTE assessment can help you identify the Severity of your Knee Pain

Determine if you are qualified for Genicalur Artery Embolization treatment

and claim your Free Knee Consultation today with one of our health professionals at a conveniently located Vascular Health Center near you.

First Name *

Last Name *

Email *

Phone *

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To get started, please verify your 5-digit zip code: *

Date of Birth *

Gender *

Female

Male

How did the pain begin? Choose all options that apply. *

Accident at home

Vehicle accident

Accident at work/work related

It just began

After surgery

Came on gradually

Sports related

Other

On a scale of 1-10, one being hardly any pain and ten being unbearable, how would you rate your pain?

What type of doctors have you seen? Choose all options that apply.

Chiropractor

Pain Management

Neurologist

Orthopaedic Surgeon

General/Family Doctor

Other

None

Have you had any surgeries to your existing pain or any other pain condition?

Yes

What areas of your life are affected by the pain? Choose all options that apply.

Maintaining a safe environment

Communication with colleagues and/or loved ones

Breathing

Eating & drinking

Washing & dressing

Mobilization

Working & playing

Expressing sexuality

Sleeping

Parenting

Finances

Household chores

Self worth/value

Physical well-being

Emotional health

Other

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