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Last Name
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Who Are You Inquiring For?
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Child's First Name
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Child's Last Name
What problem are you having?
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What problem is your child having?
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How long has your child suffered?
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Haven't - Just looking for prevention
A few days
1-2 weeks
2-4 weeks
1-3 months
Way too long!
How long have you suffered?
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Haven't - Just looking for prevention
A few days
1-2 weeks
2-4 weeks
1-3 months
Way too long!
What concerns you most?
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Not knowing what's wrong
Depending upon painkillers
Losing mobility or independence
The risk of facing dangerous surgery
Not being able to workout/stay active
Not being able to play sports
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What concerns your child most?
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Phone
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Email
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Parent's Phone Number (If You Are A Student Athlete)
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