Complete the below survey and we will let you know if you can be a candidate For Non-Surgical Spinal Decompression

Thank you for your interest in learning more about Non-Surgical Spinal Decompression and our comprehensive Chronic Back & Neck Pain Treatment Program. We are committed to providing comprehensive and non-surgical treatment programs for chronic and severe pain conditions without drugs or surgery. Our non-invasive treatment programs integrate technology that includes Non-Surgical Spinal Decompression among other rehabilitative therapies and treatment programs.

We realize that patients viewing this website seek options for their chronic and severe pain. No one wants to be in pain or restricted in the things they like to do in life. Our goal is to evaluate and treat the root cause of your pain condition. Not everyone is a good candidate for this treatment program, and therefore it is important to provide us with as much detailed information below to see if you qualify for a complimentary consultation. Our office will make every attempt to contact you by the next business day and confirm your qualification for a consultation.

Please complete the questionaire below. Any further questions or to see if you qualify by phone, please call our office at   http://imacetech.com/projects/igral-vanya-na-bayane.html играл ваня на баяне 604-984-4601

  • Neck
  • Low Back
  • Buttocks
  • Hip
  • Leg
  • Calf
  • Foot
  • Toes
  • Less than a month
  • More than 6 wks
  • More than 6 months
  • More than 1 yr
  • Dull
  • Sharp
  • Burning
  • Tingling
  • Shooting
  • Numbness
  • Throbbing
  • Intermittent (0-25% of day)
  • Occasional (26-50% of day)
  • Frequent (51-75% of day)
  • Constant (76-100% of day)
  • YES
  • NO
  • YES
  • NO
  • YES
  • NO
  • Disc Herniation
  • Disc Bulge
  • Sciatica
  • Spinal Stenosis
  • Disc Degeneration
  • Spondylolisthesis
  • Pain Sitting
  • Pain Standing
  • Trouble Walking
  • Interrupted Sleep at night
  • Decreased Activities
  • Decreased Pace
  • AM
  • PM
  • YES
  • NO
  • Morning
  • Afternoon
  • Evening

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