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Pain Profile [Company Logo Image]

 

 

 

Please tell us about you. The information that you provide will be held confidential and will assist us with a meaningful response. We'll let you know if Bonnie Prudden Myotherapy will help. A few fields are required because we prefer to locate a Certified Bonnie Prudden Myotherapist close to you to write your response, and we need to know where to send it via email. All information helps us create a meaningful response.

Please provide the following contact information:

The Shepherd's Crook comes in handy during painful times.

 

First Name (required)
Last Name 
Phone
Closest Major City (required)
State/Province (required)
Country (required)
E-mail (required)
 

What is your age?

What is your gender?


 

Briefly describe the chronic pain you have been experiencing:


 

Please describe your exercise program:

What have been your various occupations?


 

What is your history of accidents?


 

What sports have you participated in during your life?


 

Describe the outcomes of your surgeries:


 

What treatments have you already tried?


 

Which Bonnie Prudden books have you read?

Pain Erasure, The Bonnie Prudden Way
Myotherapy, Bonnie Prudden's Complete Guide to Pain Free Living
 

Is there anything else you'd like to tell us about you?


 

Would you be interested in attending a Pain Erasure workshop?

Yes No   Tip: Check our Calendar of Events page for scheduled times and locations.

Please let us know how you located our web site.


 

Thank you for your participation. A CBPM will e-mail you a response as soon as possible.

 

Send mail to info@myotherapy.org with questions or comments about this web site.
Copyright © 2002 - 2005 Sandy Hamilton, C.B.P.M.,  for the exclusive use of the International Myotherapy Association