Start the Process Online

Complete this form to get the intake process started immediately and provide our Spine Care Specialists with additional information they can use to speed up our response.

 

After you complete the form, you will immediately:

  • Receive a link to complete our pain questionnaire
  • Receive link to upload your most recent MRI (if not at one of the facilities where we have on-line access)

Within 24 hours of receipt of your imaging and your completed pain questionnaire, you will receive a phone call from one of our Spine Care Specialists in order to:

  • Review our surgeon’s assessment of your case
  • Confirm your insurance company authorization of your visit
  • If necessary, schedule you for a priority appointment (within two business days)
  • Insurance Information

    Please complete as much information as available.
  • This is normally located on the back of your insurance card.
  • Imaging Information