Getting Started on Your Path To Recovery Form The X10™ Knee Rehabilitation Machine Get X10 for use in your home. The X10 is covered by some insurances, and is available as a weekly rental. The X10 comes with your own Patient Recovery Coach, and a subscription to "The X10 Companion" - our Patient Recovery Program email series. Step 1 of 3 33% General InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Date of Birth MM DD YYYY Surgery/Procedure InformationSurgery/ProcedureScheduledNot yet scheduledI have already had surgeryDate of Surgery/Procedure Which Knee?LeftRightBoth (Bilateral)I have chosen a surgeonYesNoPlease provide a recommendationSurgeon Name First Last HospitalType of Surgery/ProcedureFirst Time Knee ReplacementManipulation Under AnesthesiaBilateral Knee ReplacementRevision SurgeryOtherDescribe Other Surgery Your Recovery PlanMy recovery will include (choose all that apply) Inpatient Care (Live In) Home Care Outpatient Care Not sure yet I would like recovery plan recommendationsYesNoYes, I want the X10 for my recovery.What can we send to you? (check all that apply) Information to review with my surgeon Home exercises (video series) Please contact me (choose all that apply) Email information to me Call me Send information in the mail How did you hear about X10™? Friend or Relative An X10 Patient Surgeon/Health Care Professional Facebook Google Search YouTube Other Name of Health Care Professional This iframe contains the logic required to handle AJAX powered Gravity Forms.
