Treatment Quiz Patient Treatment Quiz "*" indicates required fields Step 1 of 4 25% Do you have any of the following conditions? (Choose all that apply)* Facet Joint Pain Failed Back Syndrome Herniated Disc Sacroiliac Joint Pain Sciatica Spinal Deformity Spinal Injury Spinal Stenosis Spondylolisthesis Spondylosis Not Sure Are you currently undergoing any of the following treatments for your pain?* Alternative therapy Back braces Electrical nerve stimulation Exercise Injections Pain medications Spinal realignment Spinal Stenosis Other Please explain...How effective is your current treatment?Choose an option belowMy treatment plan provides effective relief, but I'm interested in trying something newMy treatment plan provides moderately effective relief, but my pain reappears in a few weeksMy treatment plan provides temporary relief, but my pain reappears in a few hours or daysMy treatment plan does not provide me with any relief or makes my pain worseI do not currently have a treatment plan to address my painHave you tried any of the following treatments? Acupuncture Anti-inflammatory medications Chiropractic care Epidural steroid injections Massage/Ultrasound Narcotic medications Orthotics Traction TENS units Trigger point injections Other Please explain...How effective were your previous treatments?Choose an option belowMy previous treatment plan was effective, but my pain has worsened since or I'm interested in trying something newMy previous treatment plan was moderately effective, but my pain never fully disappearedMy previous treatment plan seemed to provide temporary relief, but my discomfort would return in a few daysMy previous treatment plan did not affect my pain or aggravated my conditionI do not currently have a previous treatment planWhich of the following age ranges best describes you? I am a child age 10 or younger I am a pediatric patient between the ages of 11 and 18 I am a young adult between the ages of 19 and 30 I am an adult between the ages of 31 and 50 I am an adult between the ages of 51 and 65 I am older than 65 years of age Do you, or does anyone in your immediate family, suffer from any heart conditions?* Yes No Other Please explain...Would you consider yourself healthy enough for surgery?* Yes No Not Sure Can you describe any other current or treatments not listed above? Have you had any of the following medical exams or tests? (Choose all that apply)* Blood sample CT scan or X-Ray Diagnostic injections MRI Nerve conduction study Range of motion or reflex test Physical examination Other Please explain...How recent were your medical exams or tests taken?Choose an option belowLess than 2 weeks2 weeks to 1 month1 month to 6 months6 months to 1 year1 year or longerCan you describe any other medical exams not listed above? Name* First Last Phone Number*Email* Would you like to receieve additional information about our latest minimally invasive procedures?* Yes No Additional Comments or QuestionsCAPTCHA
