Request a Consultation

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Once we receive your information, we will contact you to arrange your consultation.

To protect patient privacy, please do not identify patient by name.

Contact Information
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  4. (valid email required)
Medical History Information
  1. Does the patient have
  2. Has the patient had an MRI or CAT scan for this?
  3. Is there pain in:
  4. Is there pain everyday?
  5. Describe the pain?
  6. Is there pain 24 hours a day?
  7. Is there pain, tingling, numbness, or weakness in your:
  8. Has disc surgery been recommended?
  9. Previous Back Surgery?
  10. Is there have pain at rest?
  11. Is there pain upon wakening?
  12. Is there pain below knee?
  13. Does the patient have difficulty walking?
 

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