ONLY for individuals who are serious about resolving sciatica or back pain

This application is for a free 1:1 session directly with Dr. Grant Elliott who has provided over 10,000 sessions to individuals with even the most excruciating back and sciatica pain and has canceled thousands of surgeries. This is intended for highly serious people, that understand the value of what's being offered. Dr. Elliott has not met 1:1 with any clients for a long time since our demand has required us to build a team. Only 5 people will be chosen. Good luck!

First Name *

Last Name *

Email *

Phone *

State/Country *

Age (this can relate to different spine conditions) *

What is your current occupation? *

Thanks for that info! So, how long have you been suffering with low back pain, and what happened (if anything) to cause it? *

What have you tried up until this point for your low back? *

Why do you think these efforts have been ineffective? *

Do you have sciatica? *

Yes

Have you been diagnosed with a disc herniation? *

Yes

Please select the symptoms you experience below

Longer you sit, the worse it feels

Stiff standing up straight after sitting long periods

Painful bending forward to put on socks/shoes

Increased pain with coughing or sneezing

Longer you stand the worse it feels

What does your dream life look like without low back pain? *

We are only picking 5 people for this unique opportunity. Why do you feel you should be picked? *

We need to ensure the 5 people chosen for this opportunity will 100% show up to the session, otherwise the opportunity could have been provided to someone else who would have valued it more. Would you be willing to provide a $500 refundable deposit to ensure your seat and to protect everyone's time? *

Yes

Is there any additional information you would like us to know?

Proud of you for taking this step! You might hear from us soon!

***ONLY for individuals who are serious about resolving sciatica or back pain***

ONLY for individuals who are serious about resolving sciatica or back pain