Let's explore how to reach pain free

What type of back pain are you experiencing? (Please check all which apply) *

What should we call you?

First Name *

Last Name *

How can we contact you?

Email *

Phone *

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We need a little more important information

So our doctor's can understand how to best help you, please check any of the following which describe your situation. *

Have had spinal fusion surgery within the last 3 years.

Currently have hardware from a spinal surgery fixed to your spine

Currently undergoing cancer treatment or have tumors in the area of your pain

Have implanted medical devices near the area of your pain

Have severe osteoporosis with instability

Taking one of the following medications: Marcumar, Heparin, Coumadin

Where are you located so we can match you with a provider in your area?

State *

City *

Postal code *

And finally...

Is there anything else you want to tell us or think we should know about your back pain or how it is affecting you?

Do you understand that insurance & government programs make more profit by "covering" treatments which don't make patients better. Therefore, they won't cover our treatments because our patients actually experience healing. We have pricing which is often less than people would pay with insurance but it must be paid for outside of the insurance system or with HSA funds? (Your first appointment is FREE) *

Yes