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* 1. What is your first and last name?

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* 2. What is your email address?

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* 3. What is your phone number?

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* 4. I understand and accept that there are risks and benefits associated with physical therapy and and agree to complete the exercises and stretches to my ability. I acknowledge that I should contact my primary care doctor if I have any concern about adding this exercise routine into my own health care routine . 

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