Our renowned surgical technique: NO Cutting, NO Drilling, NO Scarring.
Avoid Spine Surgery Larger than needed.
+1 800 956 6724 Beverly Hills, New York City, Los Angeles
If you're visually impaired, you can access the accessible site by pressing the Shift and Enter keys anytime.
Menu

New Patient Form

Initial Inquiry Form
This is a CONFIDENTIAL questionnaire to help us determine the best treatment plan for you. Please fill out this questionnaire

At this time, our practice is not affiliated with a trial.

Please enable JavaScript in your browser to complete this form.
Best time for us to call you
Please write down what you're curious about and what you'd like to ask here if possible, as it will be a great help for us to know what kind of assistance you need.
Are you going to have your MRI scan report faxed to our national receiving fax at 310-659-8869? (Attn: Dr. David Ditsworth, Chief of Neurosurgery)
Areas of Difficulty
Has patient had spine surgery?
Do you have Back Pain?
Do you have Leg Pain?
Leg Numbness
Leg Weakness
Which Leg is worse overall?
Any bowel, bladder or sexual difficulty? (REQUIRED)
Do you need any assistance to walk (cane, crutch, wheelchair)? (REQUIRED)
Have you had chiropractic treatments?
Do you or did you stress your back in your work?
CONSENT (REQUIRED)

Write the number in this question: 'What is five plus three?