$47 Chiropractic Exam & X-Rays Voucher

Dealing with persistent pain, aches, discomfort, or injury?

Dealing with pain, aches, or injury?

Dr. Peter

$47 Chiropractic Exam &

X-Rays Voucher ($200 Value)

This Voucher Includes A Health History Review, Consultation, Examination, Computerized Scans, X-Rays (If Necessary) & Report of Findings!

Fill out this 30-Second Survey to receive offer:

Rate the severity of your pain, aches, or injury (1 = not at all, 5 = excruciating) *

What type of pain are you experiencing? Choose all that apply. *

Low-back pain

Mid-back pain

Neck pain

Leg pain

Arm pain

Sciatica (shooting pain down the leg)

Headaches or migraines

Minor or major injuries

Other

How long have you been experiencing pain? *

Just Recently

0-6 Months

6-12 Months

More Than 12 Months

Okay! Just a few more questions regarding your appointment: Are you willing/able to invest time & financial resources into improving your health? *

Yes

I understand that the clinic's time is valuable and intend to schedule/attend an appointment. *

Yes

I understand that the clinic is located at 3476 Glen Erin Dr #210 Mississauga, ON and am willing/able to travel there regularly. *

Yes

Thank You! For a limited time, we're offering Chiropractic Exam & X-Rays Vouchers for $67 (Usually $200)! Fill out the form to claim your voucher:

Full Name *

Cell Phone *

Email *

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