Why no back surgery San Diego DRX Treatment Mission Valley spine treatment center
Rehabilitation Our Blog
 San Diego Innovative Back Pain Treatment                                        FREE Consultation!   619.692.0712 
 


  Home

  DRX Intro Video

  Why Choose Us?

  Why Not Back Surgery?

  Financing

  Choosing Treatment

  Patient Testimonials

  Rehab

  FAQs

  Go to Our Blog

Are you a good candidate for our
    Non-surgical spinal decompression program?


Answer the questionnaire below to find out...

No matter how long you’ve suffered from back and or leg pain, chances are our Healthy Back Program of Decompression therapy along with spinal stabilization and strengthening can eliminate the pain and get you back on your feet and back into an active lifestyle--all in a matter of weeks.

The first step in finding out whether our non-surgical spinal decompression program is something you should consider for ending your pain and increasing your quality of life is to fill out the pre-consultation form below. Once you submit the form, one of our doctors will review your answers and tell you if you’re a likely candidate.

Naturally, the answers you give below are not the only information we’d need to make a medically-sound decision or recommendation. But, they do provide enough data to identify those that we believe can be truly helped by our spinal decompression and rehabilitation program .

When you fill out the form, please make sure to provide a valid email address so that we can communicate with you. Or, if you prefer, please provide a phone number where we might contact you with information about your condition and our program.

 

Finally, please be assured that the information you provide is private, and will not be shared with anyone outside the clinic.

Non-surgical Spinal Decompression: Pre-consultation

* All questions with an asterisk are required
 

Last Name*: 

 

 

First Name*: 

 

Address: 

 

City: 

 

State*: 

  Zip:   

Email*: 

 

(We will email you your results – please provide valid email and add southerncalspine@yahoo.com to your white list.)

(Upon your request, one of our staff will contact you to discuss the results of this questionnaire)

Phone: 

 

1. 

* Your main complaints / symptoms: Check as many as appropriate

 Low Back Pain

 Numbness in the Legs or Feet

 Pain in one Leg

 Pain in the Hips

 Pain in both Legs

 Weakness in one or both Legs

2. 

When did your symptoms first develop?: 

  Month: 

  Year: 

 

3. 

What do you think caused them to develop?:


What activities make your symptoms worse?


What activities alleviate or reduce your symptoms?


Have your symptoms been getting progressively worse over time? Yes    No
If yes, please state time frame (e.g. “past 3 months”)  

Is this problem worse at any time of day?:    No     Morning     Midday     Evening     Other (please specify) 

4. 

* Please list previous therapies you have tried (and the results you received from each):
Medical Pain Management

 Epidural

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

 Pain Meds

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

 Surgery

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

 Facet Blocks

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

Stretching Exercises  

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

Massage

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

Physical Therapy

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

Chiropractic

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

Traction

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

Acupuncture

Helped a lot    Helped a bit / for a while    Did not help    Made me worse

5.

If you have had surgery or invasive procedures, which of these have you had?:

 IDET

 Discectomy

 Laminectomy (Lumbar)

 Spinal Cord Stimulator Implantation

 Lumbar Spinal Fusion

 Microscopic Laser Disectomy (Lumbar)

6. 

Have you had a MRI of your Low Back?
No    Yes (Date Taken):

7. 

* What are your reasons for considering Non-Surgical Spinal Decompression?
(Please mark each that applies to you)

 I want to avoid surgery

 I want to avoid long-term medication use

 Other therapies didn’t work at all

 Other therapies didn’t work enough

 Pain is preventing me from working

 Pain is interfering with my job

 My symptoms keep coming back

 Meds / drugs no longer work for me

 Surgery has made me worse

 Therapists have discharged me

 My doctor says he has done all he can do

 Pain interrupts my sleep

 Pain interferes with my social life

 I want to avoid another surgery

 Other:

8.

* Do you have (or have you been told that you have) any of the following?
(READ THIS LIST CAREFULLY)

 Have / Had Cancer (which?)

 Rheumatoid arthritis

 Osteoporosis

 Currently Pregnant

 Unstable Lumbar Spine

 Metal or Hardware from Lumbar Fusion

 Recent bone fractures

 Old compression fractures of the spine

 Tumor of spinal cord

 Bone infection

 Diabetic neuropathy

 Abdominal Aortic Aneurysm

 None of These

Explanation or question:

9. 

Would you like to receive a call from our office on your condition? 

Yes    No







FAQs about BACK PAIN:
San Diego Slipped Disc | San Diego Back Pain Relief | Spinal decompression San Diego | Sports injuries San Diego | Michael Mountain San Diego Chiropractor | San Diego Health and wellness programs | San Diego Spinal rehabilitation programs | DRX9000 San Diego Introduction Video | Mission Valley DRX9000 Research Study Results | Mission Valley Back Pain Treatment | Whiplash San Diego Auto Accident | San Diego Spinal Decompression Treatment center | Mission Valley Health Links | Add a Link Form | San Diego Patient Doctor HIPPA | | Low back pain - San Diego | Low back pain NO surgery San Diego | Ruptured disc San Diego | San Diego chronic back pain | Sciatic Nerve San Diego California constant back pain | Fix spine pain drug-free | Back hurt - no drugs, no surgery | Back pain treatment effective | San Diego treating back pain | Back Pain FAQs | |Southern California Chiropractic Center Website | | How to Find San Diego Decompression Clinic | How to not have back Surgery | San Diego Spinal Decompression Financing | Free Back Treatment DVD |




Copyright© SouthernCaliforniaSpineCenter San Diego All rights reserved
San Diego Web Marketing by Scopelink, Inc.