FIND OUT IF YOU QUALIFY FOR A FREE NEUROPATHY EXAM!

TAKE THE SURVEY BELOW TO SEE IF YOU QUALIFY!

Have You Been Diagnosed With Neuropathy Previously? *

Yes

No

Have Tried Anything To Help? *

Yes

No

Select All The Areas That Hurt *

My Left Hand

My Right Hand

My Left Foot

My Right Foot

Check All The Symptoms That Apply *

Burning

Tingling

Numbness

Ulcers

Which affordable payment options would you be interested in? *

Monthly Payment Plan Through Health Financing

My own credit card

If Needing Health Financing What Best Describes Your Credit Score? *

Below 500

500 - 580

580 - 640

640 - 720

720+

Which option best describes your monthly budget for your neuropathy treatment? *

Between $500 - $1,000

Between $1,000 - $2,000

$2,000 or More

Full Name *

Email *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

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REVOLUTIONARY, NON-Surgical Treatment!

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