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Patient Sign Up Form

Thank you for your interest in the Budwig Center. We’d like to offer you a free phone consultation. In order for us to understand your situation, please submit the form below. We will then send you an email confirmation and schedule a time for the call. If you have any questions don’t hesitate to contact us at: [email protected]

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    Your Health

    Please provide an overview of the current state of your health.

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    On a scale of 1 to 10, how bad is the pain (1 being mild, 10 being severe)

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    By ticking this box, you agree to our terms of service and privacy policy regarding how we use your personal data.

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