BAM Applicant Survey

In order for me to know where you are right now please complete the questionnaire and I’ll get right back with you to see if we’re a good fit!

Name*
First Last
Email*
Phone*
What, specifically, are you wanting to achieve?*
Why is that important to you?*
What would be the most important measure of your success as we work together?*
What's your #1 challenge when it comes to your low back pain?*
Why is having this a MUST for you now?*
What else have you tried or invested in to help you solve this problem?*
What did and didn't work?*
Be 100% honest ? What do you think is stopping you from achieving the Relief from Low back Pain you want? (The more specific you are here, the faster we can get clarity on our call together.)*
On a scale of 1-10, 1 being not committed, 10 being fully committed, how committed are you to doing whatever it takes to solve this problem now and get out of Chronic Low Back Pain?*
Please enter a number from 1 to 10.
Do you have the financial resources to invest into Getting out of Chronic Low Back Pain? Is this an important priority that you're ready, willing, and able to allocate funds towards it?*
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