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About
Resources
Request a Callback

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(321) 247-6422

Now accepting new patients in NJ & FL

SPEAK WITH AN EXPERT

(321) 247-6422

Now accepting new patients
in NJ & FL

SPEAK WITH AN EXPERT

(321) 247-6422

Now accepting new patients in NJ & FL

Treatment Assessment

Use the form below to find the best treatment options for your condition.

What condition do you have?

Bulging Disc Degenerative Disc Disease Disc Tear Facet Joint Disease Failed Fusion Surgery Failed Surgery Syndrome Foraminal stenosis Herniated Disc Pinched Nerve Radiculitis Radiculopathy Sciatica Spinal Bone Spurs Spinal Stenosis Spondylolisthesis Other

How long have you experienced this pain?

1 month or less 1 - 6 months 7 - 12 months 1 year or more

Have you undergone any of the following diagnostic studies?

CT Scan MRI Myelogram Viscogram X-Ray Nerve Conduction Study Other None of the above

How long ago was your last diagnostic study done?

1 month or less 1 - 6 months 7 - 12 months 1 year or more

Are you currently undergoing any treatment? (Select all that apply)

Medication Chiropractic Care Massage Acupuncture Epidurals Physical Therapy Nerve Block Injections Cortisone Injections Other None

If "other", please list any treatments you're currently undergoing:

How effective is your current treatment regimen?

Not Very Somewhat Very

How long does the treatment help with your pain?

1 week 2 - 4 weeks 2 - 3 months 3 - 6 months 6 - 12 months More than a year

Has a physician recommended treatment that you have not yet undergone? If so, which?

EMG Viscogram Medication Chiropractic Care Acupuncture Physical Therapy Nerve Block Nerve Block Injections Cortisone Injections Other None

If "other", please explain the course of treatment recommended to you:

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REDUCED PAIN

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Florida Locations

(321) 247-6422
Altamonte Springs FL Office
Hollywood FL Office
Orlando FL Office
Palm Beach Gardens FL Office
Altamonte Springs FL Surgical Center

New Jersey Locations

Bridgewater, NJ Office
Cherry Hill, NJ Office
Edison, NJ Office
Manalapan, NJ Office
West Orange, NJ Surgery Center
Paramus, NJ Office

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First Name

Last Name

Phone

Email

Insurance Type

Additional Comments