Free Online Consultation - Tallahassee Spinal Care

Take Our Free Online Consultation

Complete this mini-consultation, and one of our specialists will contact you by mail or email with information pertinent to your health concerns. Please be as truthful and accurate as possible.

Free Online Consultation

Gender *

Male

Female

Age Range *

Describe the most painful area *

(use a 0-10 pain scale...0 being not painful, 10 being excruciating)

When did it start and what makes it better and worse? *

If there's a second area of complaint, describe it here *

(use 0-10 pain scale)

The reason for treatment is due to a: *

Describe any condition that may be related to your pain *

(such as your general health)

Describe treatments you have received and medications that you are taking *

Do you have any of the following (if you don't know what it is, do not check the box): *

Aortic Aneurysm

Spondylolisthesis

Moderate to Severe Osteoporosis

Pregnancy

Lumbar Spinal Fusion or Metal Hardware

Spinal or Pelvic Cancer

A Recent Low Back Fracture

Connective tissue disease like Lupus, Rheumatoid Arthritis or Scleroderma

I DON'T BELIEVE I HAVE ANY OF THESE CONDITIONS

Please leave your contact information below so that we may accurately respond to your online questionnaire.

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Last

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Phone *

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Address

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If you are human, leave this field blank.

Be sure to click “SUBMIT” to send all your information. We will respond to you within 24 hours. If you need immediate attention, please call (850) 222-1171 and we will do our best to see you the same day.