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Neuropathy Protocol Survey
Which of the following neuropathy symptoms are you currently experiencing?
Please select all that apply.
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Duration of Condition:
How long have you been experiencing your symptoms?
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Severity of Condition:
On a scale of 1-10 How would you rate the severity of your symptoms?
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On a Scale of 1 – 10 with 1 being the lowest level of success and 10 being the highest, how well have you been able to manage your symptoms with your past treatments?
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Previous Treatments:
What have you done in the past to treat your neuropathy?
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Treatment Goals and Expectations:
What are your primary goals and expectations from a treatment for neuropathy?
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We offer some of the most advanced therapies available.
In some cases, we offer flexible financing options for individuals who want to take advantage of these therapies.
What best describes your current credit profile?
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Comments and Concerns:
Is there any additional information you would like to share with the Doctor before we contact you?
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Thank you for taking the first step toward better health.
Please provide your contact information below. If you’re a good fit for our services, a team member will reach out within one business day.
By Clicking this box you give consent to be contacted by Platinum Health Solutions via SMS Texting, Email, and Phone
