Spine Quiz Patient Pain Quiz Step 1 of 9 11% Where are you experiencing the most pain?(Required) Neck Arms Middle Back Lower Back Legs Have you been diagnosed with any of the following conditions?(Required) Facet Joint Pain Cervical Radiculopathy Lumbar Radiculopathy Herniated Disc Sacroiliac Joint Pain Sciatica Spinal Deformity Spinal Stenosis Spondylolisthesis Spondylosis Not Sure No Are you currently undergoing any of the following treatments for your pain?(Required) Alternative therapies Back/Neck braces Chiropractics Injections Pain medications Physical Therapy Other None Have you tried any of the following treatments?(Required) Acupuncture Anti-inflammatory medications Chiropractic care Epidural steroid injections Massage/Ultrasound Narcotic medications Orthotics/Braces Radiofrequency Ablation Spine Surgery Traction TENS units Trigger point injections Other No Can you describe any other current treatments not listed above? How effective were your previous treatments?(Required) Significant improvement Moderately effective, but my pain never fully disappeared Provided temporary relief, but my discomfort returned Did not effect my pain level or condition I do not have a previous treatment plan Which of the following age ranges best describes you?(Required) My child is 10 years of age or younger My child is between the ages of 11 and 18 I am a young adult between the ages of 19 and 30 I am an adult between the ages of 31 and 50 I am an adult between the ages of 51 and 65 I am an adult between the ages of 65 and 85 I am adult older than 85 years old Have you had any of the following medical exams or tests?(Required) CT scan MRI Nerve conduction study X-ray Other None Can you describe any other medical exams not listed above? How recent were your medical exams or tests taken?(Required) Within the last 4 weeks 1 month to 6 months 6 months to 1 year 1 year or longer Name(Required) First Last Phone(Required)Email(Required) Questions or Comments?(Required) Δ
