Sample Assessment

Take our quick 30-second survey, and our team will reach out to see if we can help:

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Question 1 of 5

How long have you been suffering with this for? *

(Select all that apply)

A

Under 6 months

B

6 - 12 months

C

1 - 2 years

D

3+ years

Question 2 of 5

Have you had surgery? *

A

Yes

B

No

Question 3 of 5

On a scale of 1 to 5 how painful is this? (1 begin little and 5 being extreme)

A

1

B

2

C

3

D

4

E

5

Question 4 of 5

What are you suffering from?

(Select all that apply)

A

Bulging Disc

B

Herniated Disc

C

Prolapsed Disc

D

Degenerative Disc Disease

E

Sciatica

F

Stenosis

G

Unsure

H

None

Question 5 of 5

What kind of symptoms are you experiencing? *

A

Sharp pain in lower back

B

Trouble standing or sitting

C

Muscle back spasms

D

Pain when walking short distances

E

Pain going down your leg

F

Pins and needles on your foot

G

None of the above

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