Inquire | Prime Performance Sports Chiropractic

+1 (516) 900-HEAL (4325) drjakealtman@gmail.com

6160 Jericho Turnpike, Commack, NY 11725

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Inquiry Form

Name *

First

Last

Pick Your Ideal Day For An Appointment *

Indicate Ideal Time *

Morning
Afternoon
Anytime

Where Is Your Pain? *

Lower Back
Neck
Shoulder
Arm
Knee
Ankle/Foot
Muscle from Sports Injury/Exercise
Not Sure

What Does it STOP You From Doing? *

What Is Your Main Concern? *

How Long Have You Suffered Or Worries? *

A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Way Too Long (years)

What is the Main Goal That You Would Like Us To Help You Achieve? *

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Prime performance sports chiropractic (PPSC)

Inquire About cost and availability

6160 Jericho Turnpike Commack, NY, 11725
+1 (516) 900-HEAL (4325)
Mon, Wed, Fri: 8-7 | Sat: By Request

1410 Broadway, New York, NY 10018
+1 (516) 900-HEAL (4325)
Tue, Thurs: 8-7

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