Schedule Appointment

Name *

Email address *

What is your primary reason for visiting the clinic?

Please select at least one option.

Injury prevention

Injury treatment

Rehabilitation

General advice

Sports performance enhancement

What type of sport or physical activity do you participate in?

Please select at least one option.

Running

Cycling

Swimming

Team sports

Weightlifting

Yoga

Other

How long have you been experiencing your current injury or issue?

Have you previously received treatment for this injury?

What is your current level of pain on a scale of 1 to 10?

Do you have any pre-existing medical conditions?

Please select at least one option.

Diabetes

Hypertension

Asthma

Heart conditions

Are you currently taking any medications?

Additional info

AP Injury Clinic