Home | Consultation Form

Consultation Form

If after looking at our site, you would like to explore the possible role of Minimal Invasive Spine Surgery in your case perhaps because you are have been told that "nothing else can be done" or you just have to "live with it" or your symptoms are "all in your mind" or you are suffering with Failed Spine Surgery or you would simply prefer to avoid the risks of conventional surgery then please complete the form below because it is likely that we can help you.

Advice over the web can only be tentative of course:

Name:

Email:

Country:

Postcode
(if UK resident):

Are your main symptoms in the neck, arm, lower back or leg?:

Is your pain on the right, left or both sides?:

What are your symptoms? (Don’t forget weakness and numbness):

How long have you had these symptoms?:

Are they worsening?:

If worsening how many months ago did this start?:

How old are you? (Age is no barrier to us).:

Whilst your first name will likely give is a clue, are you male / female:

What other illnesses do you have? (Again no barrier to us).:

Have you had previous back surgery?:

What was it?:

Did it help you? If so then for how long?:

Are you having Chronic Pain management?:

What medication do you take?:

Have you had a recent MRI scan? (Within the last year):

Do you have a copy of this scan?:

What did this or an older MRI scan show?:

What treatment is on offer to you now?:

How are these symptoms affecting your work or retirement?:

Do you want to add further information? (Please do):

And finally how did you hear about us?:

We endeavour to answer all your queries but if your enquiry gets lost in the ether and you do not get an answer within a week, then please contact us at The Spinal Foundation on:

Tel: 01260 296 346
Fax: 01260 289 019
Email: mknight@spinal-foundation.org

Happy to discuss and take on your suggestions

Martin Knight