Free Spine Assessment
Your Free Spine Assessment. Simply answer the following questions – this takes less than a minute!
First Name
*
Email Address
*
example@example.com
Phone Number (optional)
-
Area Code
Phone Number
When did your current bout of pain or symptoms start?
*
Less than 3 months ago
More than 3 months ago
Starting with any pain you may have along the spine, is it:
*
Mostly in my mid to lower back
Mostly in my upper back
Mostly in my neck
Does the pain travel down one or both of your legs?
*
Yes
No
Is there weakness in either leg or ankle?
*
Yes
No
Is there any loss of balance when walking or weakness in your legs:
*
Yes
No
Does the pain travel to your shoulder(s) and arm(s):
*
Yes
No
Is there loss of function in your arms or legs (e.g. weakness / clumsiness / unsteadiness)?
*
Yes
No
Submit
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