Do you have a herniated or bulging disc? *

Yes

I'm not sure

What is your age? *

60+

50-59

40-49

<40

Do you have an MRI of your spine (lumbar, cervical, thoracic)? *

Yes

How long have you been dealing with your pain? *

6 months

1-4 years

5-10 years

10+ years

Are you currently unable to walk and function as you wish (or have to modify the way you function)? *

Yes

Have you gotten any of these surgeries done yet? *

Discectomy or microdiscectomy

Laminectomy

Spinal Fusion

None of the above

Have you received any of the following? Check all that you've had. *

Pain medication prescribed

Epidural/Cortisone shot

Physical Therapy

Traditional Chiropractic

None of the above

Are you currently using any of the following? *

Cane

Walker

Wheelchair

None of the above

How ready do you feel to do something about your situation? *

Somewhat ready

Very ready

I need something fast!

Non-surgical, non-invasive spinal decompression treatments are not fully covered by insurance. However, many affordable payment plans are available. Are you interested in a payment plan option? *

Yes. I'm interested in affordable payment plan options.

No. I've been saving for this type of treatment and will not need a payment plan.

Payment Plan Options are available based on credit approval of the patient or a co-signer. Which best describes your credit? *

(Excellent) 750+

(Good) 650-749

(Poor) 500-649

(Very poor) Under 500

Almost done! Please fill in your contact data so we can reach you about your quiz results.

First Name *

Last Name *

What is the best number to reach you on?

Phone *

What is your best email to send you appointment information?

Email *