Diagnostic Tools

Diagnose Pain

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Step 1: Help Us Find Out Where To Start

Which statement best describes your current situation?*

I'm in pain, but I'm not sure what's causing it.

I know what's causing my pain, but I'm not sure how to relieve it.

I'm interested in a specific treatment, but I'm not sure if I qualify.

I have a diagnosis, but I would like another opinion.

Have you discussed your pain with your primary care physician?

Yes

Some

Are you interested in the latest minimally invasive and non-surgical techniques?*

Yes

Maybe

Hidden

Step 2 - Condition Checker (Hidden)

Step 2: Tell Us More About Your Pain

Where are you experiencing pain? (Choose all that apply)*

Cervical (neck) region

Thoracic (mid-spine) region

Lumbar (lower back) region

Shoulders or Arms

Hip, Buttocks, or Legs

Joints (wrists, elbows, knees, ankles, etc.)

Other

Where is your pain the most severe?

How long have you been experiencing pain?*

Hidden

Step 2 - Treatment Finder (Hidden)

Step 2: Tell Us More About Your Pain Condition

Are you suffering from any of the following conditions? (Choose all that apply)*

Arthritis

Bone Spurs

Bulging Disc

Degenerative Disc Disease

Facet Joint Disease

Failed Surgery Syndrome

Herniated Disc

Neck or Back Injury

Osteoporosis

Radiculopathy aka. Pinched Nerve

Sacroiliac Joint Dysfunction

Sciatica

Spinal Deformity

Spinal Stenosis

Spinal Tumors

Spondylolisthesis aka. Slipped Disc

Other

If other, please specify.

Hidden

Step 2 - Candidacy Verification (Hidden)

Step 2: Tell Us About Your Treatment Needs

Which procedure are you interested in?*

Axial Fusion

Cervical Disc Replacement

Coccygectomy

Endoscopic Discectomy

Endoscopic Foraminotomy

Facet Fusion

Interlaminar Spacer

Laminoforaminotomy

Laser Spine Surgery

Microdiscectomy

Orthopedic Surgery

Sacroiliac Joint Fusion

Stem Cell Therapy

TLIF

Other

If other, please specify.

Have you been diagnosed by a physician?*

Yes

How old are you?*

Are you a smoker?

Yes

Hidden

Step 2 - Second Opinion (Hidden)

Step 2: Tell Us About Your Diagnosis

Which condition or conditions do you have?*

Arthritis

Bone Spurs

Bulging Disc

Coccydynia

Degenerative Disc Disease

Disc Tear

Facet Joint Disease

Failed Surgery Syndrome

Herniated Disc

Radiculopathy aka. Pinched Nerve

Sacroiliitis

Sciatica

Spinal Stenosis

Spondylolisthesis aka. Slipped Disc

Other

Which procedure or procedures has your doctor recommended?*

Axial Fusion

Cervical Disc Replacement

Coccygectomy

Endoscopic Discectomy

Endoscopic Foraminotomy

Facet Fusion

Interlaminar Spacer

Laminoforaminotomy

Laser Spine Surgery

Microdiscectomy

Orthopedic Surgery

Sacroiliac Joint Fusion

Stem Cell Therapy

TLIF

Other

How long ago did you receive your diagnosis?

0 to 6 months

6 months to 1 year

1 to 3 years

3 years or longer

Who is your primary physician?

Hidden

Step 3 - Condition Checker (Hidden)

Step 3: Tell Us About Your Symptoms

Describe any pain-related symptoms. (Choose all that apply)*

Stabbing, shooting, or radiating pain

Tenderness, throbbing, or dull aching

Numbness, tingling, or pins-and-needles sensations

Burning or stinging

Stiffness or reduced range of motion

Localized swelling or global inflammation

Muscular cramps or spasms

Progressive weakness

Lack of balance or coordination

Difficulty walking, bending, sitting, or rotating the spine

Abnormal curvature of the spine

"Crunching" or grinding sensations in joints

Other

Hidden

Step 2.1 - Treatment Finder DETAILS (Hidden)

Step 3: Tell Us About Your Symptoms

Additional Details: Arthritis

Which type of arthritis do you have?

Ankylosing Spondylitis

Enteropathic Arthritis

Juvenile Spondylarthropathy

Osteoarthritis

Psoriatic Arthritis

Reactive Arthritis

Rheumatoid Arthritis

Not Sure or Other

Do you have Fibromyalgia?

Do you have Paget's Disease?

Which regions of your spine are affected by arthritis?

Cervical (neck) region

Thoracic (mid-spine) region

Lumbar (lower back) region

Additional Details: Bone Spurs

On which region of your spine are your bone spurs located?

Do your bone spurs affect any of the following joints?

Do you have any of the following related conditions or complications?

Ankylosing Spondylitis

Coccydynia

Degenerative Disc Disease

Facet Joint Disease

Forestier’s Disease (Diffuse Idiopathic Skeletal Hyperostosis)

Radiculopathy (Pinched Nerve Pain), Osteoarthritis

Osteoporosis

Sciatica

Spinal Stenosis

Other

Are any of the following statements true?

I’ve broken or fractured a bone before in the affected joint or spinal region

My pain began after I suffered a sudden injury (a car accident, a sports-related injury, or an unexpected fall, etc.)

Additional Details: Bulging Disc

On which region of your spine is your bulging disc located?

Do you have any of the following related conditions or complications?

Degenerative Disc Disease

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica

Other

Are any of the following statements true?

My pain began after I suffered an unexpected injury (a car accident, a weight-lifting or sports-related injury, or a fall, etc.)

My job requires a lot of sitting, standing, or heavy lifting

I am a smoker

Additional Details: Degenerative Disc Disease

On which region of your spine is your Degenerative Disc Disease located?

Do you have any of the following related conditions or complications?

Bone Spurs

Bulging Disc

Herniated Disc

Incontinence

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica

Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Other

Additional Details: Facet Joint Disease

Which region of your spine is affected by facet joint disease?

Do you have any of the following related conditions or complications?

Bone Spurs

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica, Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Synovial Cysts

Other

Have you ever had a facet joint injection or facet block?

Additional Details: Failed Surgery Syndrome

Which unsuccessful surgeries have you undergone to alleviate your neck or back pain?

Axial Fusion

Cervical Disc Replacement

Coccygectomy

Endoscopic Discectomy

Endoscopic Foraminotomy

Facet Fusions

Interlaminar Spacer

Laminoforaminotomy

Laser Spine Surgery

Microdiscectomy

Orthopedic Surgery

Sacroiliac Joint Fusion

TLIF (Transforaminal Lumbar Discectomy with Interbody Fusion)

Other

Did your failed surgical procedure result in any of the following symptoms or complications?

Inadequate or absent pain relief

Worsening pain

Pain that radiates from a new region of the spine

Infection

Nerve damage (tingling, numbness, or progressive weakness)

Paralysis or loss of sensation in the arms/legs

Muscular spasms

Reduced range of motion or lack of mobility (difficulty walking, stooping, etc.)

Loss of bowel and/or bladder control

Sexual Dysfunction

Pseudarthrosis (failed spinal fusion)

For which conditions did you undergo failed spine surgery?

Arthritis

Bone Spurs

Bulging Disc

Degenerative Disc Disease

Disc Tear

Facet Joint Disease

Herniated Disc

Pinched Nerve

Radiculopathy (Pinched Nerve Pain)

Sacroiliitis

Sciatica

Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Tailbone (Coccyx) Pain

Other

Additional Details: Herniated Disc

On which region of your spine is your herniated disc located?

Do you have any of the following conditions or complications?

Degenerative Disc Disease

Foot Drop

Incontinence

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica

Saddle Anesthesia

Other

Are any of the following statements true?

My pain began after I suffered a traumatic back or neck injury (a blow to the back or neck, a whiplash injury, a high-impact sports injury, etc.)

My job requires a lot of sitting, standing, or heavy lifting

I am a smoker

Additional Details: Neck or Back Injury

Which region of your spine is affected by a neck or back injury?

Do you have any of the following related conditions or complications?

Herniated Disc

Incontinence

Muscle Strain or Torn Muscles

Osteoporosis

Radiculopathy aka Pinched Nerve

Torn Ligaments

Partial or Complete Paralysis

Spinal Cord Injury

Spinal Fractures or Vertebral Compression Fractures

Spinal Stenosis

Spondylolisthesis aka Slipped Vertebra

Whiplash

Other

If other, please specify.

Are any of the following statements true?

I injured my neck or back in a vehicular or motorcycle accident.

I injured my neck or back while participating in contact sports.

I injured my neck or back at my job.

I injured my neck or back while lifting a heavy object.

I injured my neck or back when I suffered from a fall.

Other

If other, please specify.

Additional Details: Osteoporosis

Which type of osteoporosis do you have?

Do you have any of the following related conditions or complications?

Cancer

Calcium Deficiency

Celiac Disease

Estrogen Deficiency

Inflammatory Bowel Syndrome (IBS)

Lupus

Multiple Myeloma

Rheumatoid Arthritis

Testosterone Deficiency

Thyroid Problems

Vitamin D Deficiency

Other

If other, please specify.

Are any of the following statements true?

I have suffered from a recent vertebral compression fracture.

I am an Asian or a Caucasian female.

I am older than 65 years of age.

I have a family history of Osteoporosis.

I am undergoing (or have undergone) menopause.

I have been diagnosed with an overactive thyroid, parathyroid, or adrenal gland.

I have (or have had) an eating disorder.

I have taken long-term medications to battle cancer, seizures, or acid reflux disease.

I have had gastric bypass or gastric sleeve surgery.

Other

If other, please specify.

Additional Details: Radiculopathy aka. Pinched Nerve

Which region of your spine is affected by a pinched nerve?

Do you have any of the following conditions or complications?

Bone Spurs

Bulging Disc

Degenerative Disc Disease

Facet Joint Disease

Herniated Disc

Incontinence

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica

Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Other

Do you have any of the following spinal irregularities?

Scoliosis (Abnormal sideways curvature of the spine)

Lordosis (Swayback)

Kyphosis (Abnormal hunching of the upper back)

Are any of the following statements true:

My pain began after I suffered an injury or accident

My pain began after I had a failed surgical procedure

My job involves repetitive, heavy lifting

I am pregnant

I have Type II Diabetes

I have Fibromyalgia

I have Thyroid Disease

Additional Details: Sacroiliac Joint Dysfunction

Do you have any of the following related conditions or complications?

Ankylosing Spondylitis

Gout

Osteoarthritis

Psoriatic Arthritis

Sacroiliac Joint Dysfunction

Sacroiliac Joint Infection

Urinary Tract Infection

Other

Are any of the following statements true?

My pain began after I suffered from a recent injury (a car accident or fall, etc.)

My symptoms include fever

I am pregnant

I have Crohn’s Disease

Have you ever had a sacroiliac joint injection or a sacroiliac joint block?

Additional Details: Sciatica

Which regions of your lumbar spine or sacrum are affected by sciatic nerve compression?

Do you have any of the following related conditions or complications?

Ankylosing Spondylitis

Bulging Disc

Degenerative Disc Disease

Degenerative Scoliosis

Herniated Disc

Incontinence

Piriformis Syndrome

Sacroiliac Joint Dysfunction

Saddle Anesthesia

Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Other

Are any of the following statements true?

My pain began after I suffered from an unexpected injury

My pain began after a failed back surgery

I am pregnant

Additional Details: Spinal Deformity

Which type of spinal deformity do you have?

Flatback

Kyphosis

Lordosis or Swayback

Scoliosis

Other

If other, please specify.

Do you have any of the following related conditions or complications?

Ankylosing Spondylitis

Arthritis

Cerebral Palsy

Degenerative Disc Disease

Difficulty Breathing

Failed Neck or Back Surgery

Incontinence

Muscular Dystrophy

Osteoporosis

Paget’s Disease

Radiculopathy aka Pinched Nerve

Scheuermann’s Kyphosis

Spinal Stenosis

Spinal Tumors

Spondylolisthesis aka Slipped Vertebra

Vertebral Compression Fractures

Other

If other, please specify.

Are any of the following statements true?

I was born with a spinal deformity.

I developed a spinal deformity during adolescence.

I have a medical condition (such as muscular dystrophy or cerebral palsy) that caused my spinal deformity.

I developed a spinal deformity after a failed back or neck surgery.

I developed a spinal deformity after suffering a blow to the spine (e.g. a work or sports-related injury; a vehicular accident, etc.)

Additional Details: Spinal Stenosis

Which region of your spine is affected by spinal stenosis?

Do you have any of the following related conditions or complications?

Bone spurs

Difficulty walking (Claudication)

Facet Joint Disease

Herniated Disc

Incontinence

Osteoarthritis

Paget’s Disease

Paralysis

Radiculopathy (Pinched Nerve Pain)

Rheumatoid Arthritis

Saddle Anesthesia or Cauda Equina Syndrome

Sciatica

Spinal Cord Injury

Spinal Tumors

Thickened Ligamentum Flavum

Other

Are any of the following statements true?

My pain began after I suffered from a recent injury

I have a spinal defect that was present at birth, such as scoliosis or kyphosis

Additional Details: Spinal Tumors

Which type of spinal tumor(s) do you have?

Intradural-Extramedullary Tumors

Intramedullary Tumors

Vertebral Column Tumors

Unknown

Other

If other, please specify.

Additional Details: Intradural-Extramedullary Tumors

Meningioma

Neurofibroma

Schwannoma

Unknown

Other

If other, please specify.

Additional Details: Intramedullary Tumors

Astrocytoma

Ependymoma

Hemangioma

Lipoma

Unknown

Other

If other, please specify.

Additional Details: Vertebral Column Tumors

Osteoblastoma

Osteoid Osteoma

Osteogenic Sarcoma

Unknown

Other

If other, please specify.

Where are your spinal tumors located?

Do you have any of the following complications?

Incontinence

Muscular Weakness

Paralysis (partial or complete)

Radiculopathy aka. Pinched Nerve

Spinal Deformity (e.g. Scoliosis or Kyphosis)

Spinal Stenosis

Other

If other, please specify.

Are any of the following statements true?

I have a metastatic or malignant spinal tumor.

My spinal tumor spread from a primary cancer located elsewhere in my body (e.g. lung, breast, liver, or prostate cancer, etc).

My child has been diagnosed with a pediatric spinal tumor.

I am diagnosed with an autoimmune disease, Neurofibromatosis 2, or Von Hippel-Lindau Disease.

Other

If other, please specify.

Additional Details: Spondylolisthesis aka. Slipped Disc

Which region of your spine is affected by spondylolisthesis?

Which type of spondylolisthesis do you have?

Which grade of vertebral slippage do you have?

Are any of the following statements true?

My pain began after I suffered from an injury

My pain is the result of a stress fracture

I participate in high-impact sports (gymnastics, football, weightlifting, hockey, etc.)

I am an adolescent

I have arthritis

Hidden

Step 3.1 - Condition Checker DETAILS (Hidden)

Step 3.1: We Need A Little More Info

Additional Details: Stabbing, shooting or radiating pain

Where are you experiencing stabbing, shooting or radiating pain?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

How intense is the stabbing, shooting or radiating pain?

0	1	2	3	4	5

Additional Details: Tenderness, throbbing or dull aching

Where are you experiencing tenderness, throbbing, or dull aching?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

How severe is the tenderness, throbbing or dull aching?

0	1	2	3	4	5

Additional Details: Numbness, tingling or pins-and-needles sensations

Where are you experiencing numbness, tingling, or pins-and-needles sensations?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Is the numbness, tingling, or pins-and-needles sensation constant?

Yes

Comes and goes

How intense is the numbness, tingling, or pins-and-needles sensations?

0	1	2	3	4	5

Additional Details: Burning or stinging

Where are you experiencing burning or stinging?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Is the burning or stinging constant?

Yes

Comes and goes

How severe is the burning or stinging?

0	1	2	3	4	5

Additional Details: Stiffness or reduced range of motion

Where are you experiencing stiffness?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Where are you experiencing reduced range of motion?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Additional Details: Localized swelling or global inflammation

Where are you experiencing swelling or inflammation?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

How severe is swelling or inflammation?

0	1	2	3	4	5

Additional Details: Muscular cramps or spasms

Where are you experiencing muscular cramps or spasms?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Do the cramps or spasms limit your ability to walk or move freely?

Yes

Sometimes

Additional Details: Progressive weakness

Where are you experiencing progressive weakness?

Upper Extremities – Arms or Hands

Lower Extremities – Legs or Feet

Step 4: Patient History & Previous Treatments

Have you tried any of the following treatments?*

Self-care (rest, over-the-counter medications, ice & heat application, etc.)

Alternative Therapy (Yoga, Acupuncture, Massage Therapy)

Chiropractic Care

Physical Therapy

Pain Management (prescription strength pain medication, cortisone injections, etc.)

Surgical Intervention

Other

If other, please specify.

Step 4: MRI & Imaging Report Information

Have you undergone any of the following tests?*

CT Scan

MRI

X-RAY

EMG or Nerve Conduction Study

Other

If other, please specify.

How long ago did you receive your MRI?

0 to 6 months

6 months to 1 year

1 to 2 years

2 years or more

Where is your MRI report?

Step 5: Health Insurance Information

Select your primary state coverage.*

What type of insurance do you have?*

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

Health Maintenance Organization (HMO)

Personal Injury Protection (PIP)

Worker's Compensation

Medicare

Medicaid

Self Pay

Other or Unknown

Who is your primary insurance carrier?

Step 6: Get Your Results

First Name*

Last Name*

Email*

Phone*

Best Time to Contact You

As soon as possible

Morning

Afternoon

Evening

Additional Comments or Questions?

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Check Condition

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Step 1: Tell Us About Your Pain

Where are you experiencing pain? (Choose all that apply)*

Cervical (neck) region

Thoracic (mid-spine) region

Lumbar (lower back) region

Shoulders or Arms

Hip, Buttocks, or Legs

Joints (wrists, elbows, knees, ankles, etc.)

Other

Where is your pain the most severe?

How long have you been experiencing pain?

0 to 6 months

6 months to 1 year

1 to 2 years

2 years or more

Step 2: Tell Us About Your Symptoms

Describe any pain-related symptoms. (Choose all that apply)*

Stabbing, shooting, or radiating pain

Tenderness, throbbing, or dull aching

Numbness, tingling, or pins-and-needles sensations

Burning or stinging

Stiffness or reduced range of motion

Localized swelling or global inflammation

Muscular cramps or spasms

Progressive weakness

Lack of balance or coordination

Difficulty walking, bending, sitting, or rotating the spine

Abnormal curvature of the spine

"Crunching" or grinding sensations in joints

Other

Step 2.1: We Need A Little More Information

Where are you experiencing stabbing, shooting, or radiating pain?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

How intense is the stabbing, shooting or radiating pain?

0	1	2	3	4	5

Where are you experiencing tenderness, throbbing or dull aching?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

How severe is the tenderness, throbbing or dull aching?

0	1	2	3	4	5

Where are you experiencing numbness, tingling, or pins-and-needles sensations?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Is the numbness, tingling or pins-and-needles sensation constant?

Yes

Comes and goes

How intense is the numbness, tingling, or pins-and-needles sensations?

0	1	2	3	4	5

Where are you experiencing burning or stinging?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Is the burning or stinging constant?

Yes

Comes and goes

How severe is the burning or stinging?

0	1	2	3	4	5

Where are you experiencing stiffness?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Where are you experiencing reduced range of motion?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Where are you experiencing swelling or inflammation?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

How severe is the swelling or inflammation?

0	1	2	3	4	5

Where are you experiencing muscular cramps or spasms?

Neck

Shoulders

Arms

Hands

Lower Back

Hips

Buttocks

Legs

Feet

Do the cramps or spasms limit your ability to walk or move freely?

Yes

Sometimes

Where are you experiencing progressive weakness?

Upper Extremities – Arms or Hands

Lower Extremities – Legs or Feet

Step 3: Tell Us About Your Pain History

Which circumstance resulted in your pain?*

If other, please specify.

Have you undergone any of the following tests?*

CT Scan

MRI

X-Ray

EMG or Nerve Conduction Study

Other

Have you tried any of the following treatments?

Self-care (rest, over-the-counter medications, ice & heat application, etc.)

Alternative Therapy (Acupuncture, Yoga, Massage Therapy, etc.)

Chiropractic Care

Physical Therapy

Pain Management (prescription strength pain medication, cortisone injections, etc.)

Surgical Intervention

None

Other

If other, please specify.

What type of insurance do you have?*

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

Health Maintenance Organization (HMO)

Personal Injury Protection (PIP)

Worker's Compensation

Medicare

Medicaid

Self Pay

Other or Unknown

Step 4: Get My Condition Results

First Name*

Last Name*

Email*

Phone Number*

Best Time to Contact You

As soon as possible

Morning

Afternoon

Evening

Additional Comments or Questions?

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Find Treatments

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Step 1: Tell Us More About Your Pain

Which condition do you have?*

Arthritis

Bone Spurs

Bulging Disc

Degenerative Disc Disease

Facet Joint Disease

Failed Surgery Syndrome

Herniated Disc

Neck or Back Injury

Osteoporosis

Radiculopathy aka. Pinched Nerve

Sacroiliac Joint Dysfunction

Sciatica

Spinal Deformity

Spinal Stenosis

Spinal Tumors

Spondylolisthesis aka. Slipped Disc

Other

If other, please specify.

Step 1.1: We Need a Little More Information

Additional Details: Arthritis

Which type of arthritis do you have?

Ankylosing Spondylitis

Enteropathic Arthritis

Juvenile Spondylarthropathy

Osteoarthritis

Psoriatic Arthritis

Reactive Arthritis

Rheumatoid Arthritis

Not Sure or Other

Do you have Fibromyalgia?

Do you have Paget’s Disease?

Which region of your spine are affected by arthritis?

Additional Details: Bone Spurs

On which region of your spine are your bone spurs located?

Do your bone spurs affect any of the following joints?

Do you have any of the following related conditions or complications?

Ankylosing Spondylitis

Coccydynia

Degenerative Disc Disease

Facet Joint Disease

Forestier’s Disease (Diffuse Idiopathic Skeletal Hyperostosis)

Radiculopathy (Pinched Nerve Pain), Osteoarthritis

Osteoporosis

Sciatica

Spinal Stenosis

Other

Are any of the following statements true?

I’ve broken or fractured a bone before in the affected joint or spinal region

My pain began after I suffered a sudden injury (a car accident, a sports-related injury, or an unexpected fall, etc.)

Additional Details: Bulging Disc

On which region of your spine is your bulging disc located?

Do you have any of the following related conditions or complications?

Degenerative Disc Disease

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica

Other

Are any of the following statements true?

My pain began after I suffered an unexpected injury (a car accident, a weight-lifting or sports-related injury, or a fall, etc.)

My job requires a lot of sitting, standing, or heavy lifting

I am a smoker

Additional Details: Degenerative Disc Disease

On which region of your spine is your Degenerative Disc Disease located?

Do you have any of the following related conditions or complications?

Bone Spurs

Bulging Disc

Herniated Disc

Incontinence

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica

Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Other

Additional Details: Facet Joint Disease

Which region of your spine is affected by facet joint disease?

Do you have any of the following related conditions or complications?

Bone Spurs

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica, Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Synovial Cysts

Other

Have you ever had a facet joint injection or facet block?

Additional Details: Failed Surgery Syndrome

Which unsuccessful surgeries have you undergone to alleviate your neck or back pain?

Axial Fusion

Cervical Disc Replacement

Coccygectomy

Endoscopic Discectomy

Endoscopic Foraminotomy

Facet Fusions

Interlaminar Spacer

Laminoforaminotomy

Laser Spine Surgery

Microdiscectomy

Orthopedic Surgery

Sacroiliac Joint Fusion

TLIF (Transforaminal Lumbar Discectomy with Interbody Fusion)

Other

If other, please specify.

Did your failed surgical procedure result in any of the following symptoms or complications?

Inadequate or absent pain relief

Worsening pain

Pain that radiates from a new region of the spine

Infection

Nerve damage (tingling, numbness, or progressive weakness)

Paralysis or loss of sensation in the arms/legs

Muscular spasms

Reduced range of motion or lack of mobility (difficulty walking, stooping, etc.)

Loss of bowel and/or bladder control

Sexual Dysfunction

Pseudarthrosis (failed spinal fusion)

For which conditions did you undergo failed spine surgery?

Arthritis

Bone Spurs

Bulging Disc

Degenerative Disc Disease

Disc Tear

Facet Joint Disease

Herniated Disc

Pinched Nerve

Radiculopathy (Pinched Nerve Pain)

Sacroiliitis

Sciatica

Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Tailbone (Coccyx) Pain

Other

Additional Details: Herniated Disc

On which region of your spine is your herniated disc located?

Do you have any of the following conditions or complications?

Degenerative Disc Disease

Foot Drop

Incontinence

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica

Saddle Anesthesia

Other

Are any of the following statements true?

My pain began after I suffered a traumatic back or neck injury (a blow to the back or neck, a whiplash injury, a high-impact sports injury, etc.)

My job requires a lot of sitting, standing, or heavy lifting

I am a smoker

Additional Details: Neck or Back Injury

Which region of your spine is affected by a neck or back injury?

Do you have any of the following related conditions or complications?

Herniated Disc

Incontinence

Muscle Strain or Torn Muscles

Osteoporosis

Radiculopathy aka Pinched Nerve

Torn Ligaments

Partial or Complete Paralysis

Spinal Cord Injury

Spinal Fractures or Vertebral Compression Fractures

Spinal Stenosis

Spondylolisthesis aka Slipped Vertebra

Whiplash

Other

If other, please specify.

Are any of the following statements true?

I injured my neck or back in a vehicular or motorcycle accident.

I injured my neck or back while participating in contact sports.

I injured my neck or back at my job.

I injured my neck or back while lifting a heavy object.

I injured my neck or back when I suffered from a fall.

Other

If other, please specify.

Additional Details: Osteoporosis

Which type of osteoporosis do you have?

Do you have any of the following related conditions or complications?

Cancer

Calcium Deficiency

Celiac Disease

Estrogen Deficiency

Inflammatory Bowel Syndrome (IBS)

Lupus

Multiple Myeloma

Rheumatoid Arthritis

Testosterone Deficiency

Thyroid Problems

Vitamin D Deficiency

Other

If other, please specify.

Are any of the following statements true?

I have suffered from a recent vertebral compression fracture.

I am an Asian or a Caucasian female.

I am older than 65 years of age.

I have a family history of Osteoporosis.

I am undergoing (or have undergone) menopause.

I have been diagnosed with an overactive thyroid, parathyroid, or adrenal gland.

I have (or have had) an eating disorder.

I have taken long-term medications to battle cancer, seizures, or acid reflux disease.

I have had gastric bypass or gastric sleeve surgery.

Other

If other, please specify.

Additional Details: Radiculopathy aka. Pinched Nerve

Which region of your spine is affected by a pinched nerve?

Do you have any of the following conditions or complications?

Bone Spurs

Bulging Disc

Degenerative Disc Disease

Facet Joint Disease

Herniated Disc

Incontinence

Osteoarthritis

Radiculopathy (Pinched Nerve Pain)

Sciatica

Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Other

Do you have any of the following spinal irregularities?

Scoliosis (Abnormal sideways curvature of the spine)

Lordosis (Swayback)

Kyphosis (Abnormal hunching of the upper back)

Are any of the following statements true:

My pain began after I suffered an injury or accident

My pain began after I had a failed surgical procedure

My job involves repetitive, heavy lifting

I am pregnant

I have Type II Diabetes

I have Fibromyalgia

I have Thyroid Disease

Additional Details: Sacroiliac Joint Dysfunction

Do you have any of the following related conditions or complications?

Ankylosing Spondylitis

Gout

Osteoarthritis

Psoriatic Arthritis

Sacroiliac Joint Dysfunction

Sacroiliac Joint Infection

Urinary Tract Infection

Other

Are any of the following statements true?

My pain began after I suffered from a recent injury (a car accident or fall, etc.)

My symptoms include fever

I am pregnant

I have Crohn’s Disease

Have you ever had a sacroiliac joint injection or a sacroiliac joint block?

Additional Details: Sciatica

Which regions of your lumbar spine or sacrum are affected by sciatic nerve compression?

Do you have any of the following related conditions or complications?

Ankylosing Spondylitis

Bulging Disc

Degenerative Disc Disease

Degenerative Scoliosis

Herniated Disc

Incontinence

Piriformis Syndrome

Sacroiliac Joint Dysfunction

Saddle Anesthesia

Spinal Stenosis

Spondylolisthesis (Slipped Vertebra)

Other

Are any of the following statements true?

My pain began after I suffered from an unexpected injury

My pain began after a failed back surgery

I am pregnant

Additional Details: Spinal Deformity

Which type of spinal deformity do you have?

Flatback

Kyphosis

Lordosis or Swayback

Scoliosis

Other

If other, please specify.

Do you have any of the following related conditions or complications?

Ankylosing Spondylitis

Arthritis

Cerebral Palsy

Degenerative Disc Disease

Difficulty Breathing

Failed Neck or Back Surgery

Incontinence

Muscular Dystrophy

Osteoporosis

Paget’s Disease

Radiculopathy aka Pinched Nerve

Scheuermann’s Kyphosis

Spinal Stenosis

Spinal Tumors

Spondylolisthesis aka Slipped Vertebra

Vertebral Compression Fractures

Other

If other, please specify.

Are any of the following statements true?

I was born with a spinal deformity.

I developed a spinal deformity during adolescence.

I have a medical condition (such as muscular dystrophy or cerebral palsy) that caused my spinal deformity.

I developed a spinal deformity after a failed back or neck surgery.

I developed a spinal deformity after suffering a blow to the spine (e.g. a work or sports-related injury; a vehicular accident, etc.)

Additional Details: Spinal Stenosis

Which region of your spine is affected by spinal stenosis?

Do you have any of the following related conditions or complications?

Bone spurs

Difficulty walking (Claudication)

Facet Joint Disease

Herniated Disc

Incontinence

Osteoarthritis

Paget’s Disease

Paralysis

Radiculopathy (Pinched Nerve Pain)

Rheumatoid Arthritis

Saddle Anesthesia or Cauda Equina Syndrome

Sciatica

Spinal Cord Injury

Spinal Tumors

Thickened Ligamentum Flavum

Other

Are any of the following statements true?

My pain began after I suffered from a recent injury

I have a spinal defect that was present at birth, such as scoliosis or kyphosis

Additional Details: Spinal Tumors

Which type of spinal tumor(s) do you have?

Intradural-Extramedullary Tumors

Intramedullary Tumors

Vertebral Column Tumors

Unknown

Other

If other, please specify.

Additonal Details: Intradural-Extramedullary Tumors

Meningioma

Neurofibroma

Schwannoma

Unknown

Other

If other, please specify.

Additonal Details: Intramedullary Tumors

Astrocytoma

Ependymoma

Hemangioma

Lipoma

Unknown

Other

If other, please specify.

Additonal Details: Vertebral Column Tumors

Osteoblastoma

Osteoid Osteoma

Osteogenic Sarcoma (After you click on VCT, sub-items should appear)

Unknown

Other

If other, please specify.

Where are your spinal tumors located?

Do you have any of the following complications?

Incontinence

Muscular Weakness

Paralysis (partial or complete)

Radiculopathy aka. Pinched Nerve

Spinal Deformity (e.g. Scoliosis or Kyphosis)

Spinal Stenosis

Other

If other, please specify.

Are any of the following statements true?

I have a metastatic or malignant spinal tumor.

My spinal tumor spread from a primary cancer located elsewhere in my body (e.g. lung, breast, liver, or prostate cancer, etc).

My child has been diagnosed with a pediatric spinal tumor.

I am diagnosed with an autoimmune disease, Neurofibromatosis 2, or Von Hippel-Lindau Disease.

Other

If other, please specify.

Additional Details: Spondylolisthesis aka. Slipped Disc

Which region of your spine is affected by spondylolisthesis?

Which type of spondylolisthesis do you have?

Which grade of vertebral slippage do you have?

Are any of the following statements true?

My pain began after I suffered from an injury

My pain is the result of a stress fracture

I participate in high-impact sports (gymnastics, football, weightlifting, hockey, etc.)

I am an adolescent

I have arthritis

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Step 2: Tell Us About Your Previous Treatments

Have you undergone any of the following tests?*

CT Scan

MRI

X-RAY

EMG or Nerve Conduction Study

Other

If other, please specify.

Have you tried any of the following treatments?*

Self-care (rest, over-the-counter medications, ice & heat application, etc.)

Alternative Therapy (Yoga, Acupuncture, Massage Therapy)

Chiropractic Care

Physical Therapy

Pain Management (prescription strength pain medication, cortisone injections, etc.)

Surgical Intervention

Other

If other, please specify.

Step 3: Find A Treatment

First Name*

Last Name*

Email*

Phone Number*

Best Time to Contact You

As soon as possible

Morning

Afternoon

Evening

Additional Comments or Questions?

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Comments

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Confirm Eligibility

"*" indicates required fields

Step 1: Tell Us About Your Treatment Needs

Which procedure are you interested in?*

Anterior Cervical Discectomy & Fusion (ACDF)

Anterior Lumbar Interbody Fusion (ALIF)

Artificial Disc Replacement

Endoscopic Discectomy

Extreme Lateral Interbody Fusion (XLIF)

Foraminotomy

Kyphoplasty

Laminectomy or Laminotomy

Laser Spine Surgery

Microdiscectomy

Posterior Cervical Fusion

Revision Spine Surgery

Sacroiliac Joint Fusion

Transforaminal Lumbar Interbody Fusion (TLIF)

Vertebroplasty

Other

If other, please specify.

Have you been diagnosed by a physician?

Yes

How old are you?

Younger than 25 years old

25 - 34 years old

35 - 44 years old

45-54 years old

55-64 years old

65 years old or older

Are you a smoker?

Yes

Step 2: MRI Specifications & Details

Have you had a MRI?*

Yes

How long ago did you receive your MRI?

0 to 6 months

6 months to 1 year

1 to 2 years

2 years or more

Step 3: Health Insurance Information

Select the state where you receive primary insurance coverage.*

What type of insurance do you have?*

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

Health Maintenance Organization (HMO)

Personal Injury Protection (PIP)

Worker's Compensation

Medicare

Medicaid

Self Pay

Other or Unknown

Who is your primary insurance carrier?

Step 4: Verify Your Eligibility

First Name*

Last Name*

Email*

Phone Number*

Best Time to Contact You

As soon as possible

Morning

Afternoon

Evening

Additional Comments or Questions?

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MRI Review

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Step 1: MRI Specifications & Details

What type of MRI do you have?*

Cervical (neck) region

Thoracic (mid-spine) region

Lumbar (lower back) region

Shoulders or Arms

Hip, Buttocks, or Legs

Joints (wrists, elbows, knees, ankles, etc.)

Not Sure

How long ago did you receive your MRI?*

0 to 6 months

6 months to 1 year

1 to 2 years

2 years or more

Where is your MRI report?

Step 2: Health Insurance Information

Select your primary state coverage.*

What type of insurance do you have?*

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

Health Maintenance Organization (HMO)

Personal Injury Protection (PIP)

Worker's Compensation

Medicare

Medicaid

Self Pay

Other or Unknown

Who is your primary insurance carrier?

Step 3: Get Your Free Review

First Name*

Last Name*

Email*

Phone Number*

Best Time to Contact You

As soon as possible

Morning

Afternoon

Evening

Additional Comments or Questions?

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