Painless Trigger Point 
  Intake Form
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  If you have any questions don't hesitate to call or email Raj at 310-930-5884 or
  Firstname*:   Lastname*:   Consultation Type*:
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  Current Sport/Exercise*: Previous Sport/Exercise:*  
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  Recent Injury*
  Old Injury:*   Ailment Period*:  
History* Describe your observtions re the development of the condition in each of your affected areas from when you first noticed it, even in its mildest form. This information is vital for an acurate evaluation.
Previous Treatments and Results*:
  Your Short-term and Ultimate Goals*:
  Hand Strength*:   Trigger Point Knowledge*: