Please answer the following questions. Only answer with information that you are comfortable sharing with us (there are some required basic details we need to process your order). We want to assure you that all of your information is private and confidential. We will not share your results with anyone outside of Live Rehab. The more information that you are willing to provide, the more individualized your plan will be.
This is a three part survey. You can start and stop the survey whenever you want but please be sure to save as you go. There are twenty questions in each section so the time that it takes to answer each section is up to how much information you are willing to share.