Book your Pain consultation and treatment with Dr. Sunny Gill at Rome Spine and Wellness.$125 $75 (40% livforr member discount) Paid in office upon arrival Name * First Name Last Name Email * Phone * (###) ### #### Preferred Appointment Date MM DD YYYY Preferred Appointment Time 10am 11am 1pm 2pm 4pm i might need later What is your chief complaint? * (Select all that apply) Joint Pain Weight Loss Neuropothy Something Else Tell us more about your chief complaint: (Optional) Do you have any barriers that prevent you from following a care plan? Discipline. Consistnecy Finances Schedule Other None How Committed are you to receiving care? 10 - will show up to every appointment and make every change i need to 8 - ready to get better but won't be disciplined and consistent 5 - will show up to appointments, wont change lifestyle 1 - not committed at all Thank you for booking your appointment with Dr. Sunny Gill at Rome Spine and WellnessA member of the Rome Spine and Wellness staff will contact you within 24 hours to confirm your appointment with you.Rome Spine and Wellness706-842-7215www.Romespineandwellness.com