• New Patient

Please take a moment to answer the following questions. Thank you!

Are you currently employed?

How do you describe your pain?

Which best describes the frequency of your pain?

How has your condition/pain affected your daily life and activities?

Have you previously contacted another doctor about your pain?

Have you had any surgeries?

Have you been diagnosed with any of the following?

Have you had any recent imaging (within the last 6 months) such as MRI, Xray or CT-Scan?

Do you have a pacemaker or spinal stimulator?

Have you been in a recent auto accident or slip and fall?

If so, are you currently in an active ongoing case?

All Survey data is collected in a confidential manner: no uniquely identifiable information about survey respondents will be gathered and/or shared at any time. The contents of this web site are for informational purposes only. This site is not intended to furnish medical advice to anyone. Any diagnosis, treatment or care of a patient should be discussed with a physician.

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