Let’s Start The Conversation with Dr. Couch’s Team

Name *

First Name

Last Name

Phone *

(###)

###

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Are you an existing patient? *

Yes

No

Where are you currently experiencing pain? *

Hip

Knee

Other

Is this the result of a car accident or a workers comp case? *

Yes

No

Have you had recent X-Rays or MRI of the area that hurts? *

Yes

No