Excellence Shock Wave Therapy

What is ESWT?
Extracorporeal
Shock Wave Therapy

ESWT Cures:
• Plantar Fasciitis (heel spurs)
• Achilles Tendonitis
• Tennis Elbow
• Shoulder Tendonitis

Our state-of-the-art Mobile Treatment Center provides ESWT in a safe, plush and comfortable environment, as well as in participating surgery centers and physician offices. During treatment, you can read, watch television, enjoy a refreshment and relax. We do everything we can to make your experience comfortable, even enjoyable.

ESWT Contact Form
Questionnaire

Please take a moment to complete the brief questionnaire form below. The information you provide will help us get a better idea about you and your current condition.

You will receive a response from one of our staff within one business day. If you do not receive a response or have a question or concern that needs quicker attention, you can still contact us by phone at:

Toll Free: 1-877-813-0552
In NJ: 856-769-8270

Section 1: About You

First name:
Last name:
Company:
Address:
City:
State:
Zip code:
Home phone:
Work phone:
Ext:
Email:
Alternate email:
Preferred method of contact:
How did you hear about ESWT?
If you selected "other":

Section 2: About Physical Condition

Have you seen a podiatrist or orthopedic physician for this condition?
If yes, what was the diagnosis of your condition?
How long have you had pain from this condition?
Where do you feel the most pain?
Did this start as a result of an injury?
If yes, please describe injury:
On a scale of 1 to 10 (10 being worst), how would you rate your pain when it is at its worst?
Does anyone else in your family have the same problem?
What treatments have you tried on your own and/or with your doctor?
How does your condition interfere with your daily activities?
Do you have other painful areas due to walking funny (example: knees, back, hip pain, etc)?
What kind of insurance do you have?

Section 3: Questions & Comments

Any other questions or comments:



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