Book Your Free Roadmap To Pain-Free Movement

What Happen's Next?

We’ll review your application & you'll be directed to book your Video Call -

Personalised Roadmap To Pain-Free Movement

Roadmap To Pain-Free Movement

Hey, this quick form helps us learn more about you.

At the end, you’ll be able to book a Free Call to see if we are the solution you’ve been looking for. Looking forward to chatting with you!

Height *

Weight *

Date of birth *

Pain Area *

Occupation / Vocation *

On a scale of 1 to 10, how would you rate the severity of your pain? *

0

1

2

3

4

5

6

7

8

9

10

How would you describe your pain? (Select all that apply) *

Left side

Right side

Dull / Nagging

Stiffness

Sharp

Shooting / Stabbing

Burning / Numbness

Local pain

Spreading pain

How long has the pain been troubling you? *

1 - 7 days

2 - 4 weeks

2 - 3 months

3 - 6 months

6 - 9 Months

9+ months

Did this pain start from a specific injury or event? *

In your own words how does this pain / injury impact your day? *

Have you had any scans MRI's, X-ray's, CT-Scans or Ultrasounds? *

Yes

No

Add any Medical Imaging + Reports Here

What have you tried? (Select all that apply) *

Physiotherapy (Physical therapy)

Massage

Remedial massage

Myotherapy

Chiropractic

Osteopathy

Medication

Cortisone injections

Surgery

Pilates

Figuring it out on my own

Youtube Exercises

Acupuncture

Nothing Yet

Were these treatments effective? *

Yes, but only short-term relief

No, they didn’t work for me

I wasn’t consistent with them

Somewhat helpful, but I need a more structured, long-term plan

Are you currently on a structured pain management plan? *

Yes

No

Why Is Fixing This Important to You? *

It’s severely impacting my everyday life

It’s holding me back in training & fitness

I’ve put this off for too long, and I’m done waiting

My health is too important to ignore

I want to be stronger, fitter & perform at my best

I need to get back to living without pain or fear

What do you want most from this program? (Select all that apply) *

Eliminate pain permanently

Regain strength & confidence in movement

Improve mobility & flexibility

Get back to lifting, running & training without fear

Prevent future injuries & bulletproof my body

All The Above

How ready are you to commit to a structured rehabilitation plan for at least 12 weeks? *

1 - Extremely important

2 - Very important

3 - Somewhat important

4 - Not at all important

5 - Not so important

Can you dedicate time to your recovery? *

30mins

60mins

90mins

120mins

150mins

Fast forward 6 months… Your pain is gone, your strength is back. What does life look like for you? *

If we could guarantee your result, would anything hold you back from committing? *

Financial reasons

Time commitments

Fear of another failed attempt

Need to check with a partner

No, I’m fully ready to start

If using Private Health Insurance, please provide your provider name: *

Is there anyone who you'd like to be involved in helping you make your decision before committing to our Program (ie a partner)? *

Yes - I will ensure they are also able to make the call and to be a part of the decision making process

Yes - But the decision is ultimately mine to make

No - I know I'll be able to make the decision myself

How did you hear about Myofunction? *

Family / Friend Referral

Invictus 5

Snap Fitness Carina

Coorparoo Market Place Pharmacy

Instagram

Your Name *

Phone *

Email *

Final Step: Book Your Free Call On The Next Page *

Matthew is 100% committed to your success.

Once you submit this form, you'll be directed to book your 1:1 Roadmap to Pain-Free Movement

This call is where we map out your step-by-step plan to eliminate pain and rebuild strength.

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