Disc Test

1. Are you currently experiencing neck or back pain?

Yes

No

2. Does the pain radiate into your hip, buttock or leg? Does it radiate into your shoulder, arm or hand?

Yes

No

3. Do you have numbness or tingling in your leg/foot or your arm/hand?

Yes

No

4. Have you had these symptoms for more than three months?

Yes

No

5. Have you been diagnosed with any of the following:

Slipped, Herniated or Bulging Disc

Degenerative Disc Disease

Spondylolisthesis

Sciatica

Facet Syndrome

Spinal Stenosis

Failed Back Surgery

6. Have any of the following treatments been unsuccessful:

Over-The-Counter Medications

Physical Rehabilitation Therapy

Inversion Therapy

Prescription Medications

Epidural Steroid Injections

Spine Surgery

Chiropractic Adjustments

Acupuncture

7. Because of Pain do you:

Stay home more of the time/get out less?

Limit your work or household chores?

Restrict your family and recreational activities?

Free Text

If you answered Yes to multiple questions you could be a candidate for our non-surgical, safe, FDA cleared treatment procedures. Schedule you’re free consultation with our chiropractor in Highlands Ranch, submit the form below!

Name

Email

Phone

Zip Code

Free Text

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Pinnacle Chiropractic and Spinal Rehab Center of Highlands Ranch