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* 1. Name:

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* 2. Are you aware of the remote physiotherapy services we are currently offering? Please click here, if you are not.

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* 3. Are you considering one of our remote physiotherapy services? Please click the service you are most interested in.

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* 4. If you answered that you are NOT interested in any of our remote services we would like to know why & will not be offended! Please select the answers that apply to you.

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* 5. If you answered above that you are in some pain or unsure on how we can help remotely, would you like a physiotherapist to call you for a free 10 minute consultation?

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* 6. If you have already had a remote consultation would you like to leave us some feedback or provide a testimonial? Please use the comment box below.

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