Free On-Line Consultation...Ask The Doctor   Here's your chance for a mini-consultation with one of our doctors. If you fill out this form and submit it, we will write or call you back with our opinion. Please be as truthful and accurate as possible. Items marked with * are required   * Your First and Last Name     * What is your sex? Male Female   * What is your age range? 0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 over 90   * Where does it hurt (check all the areas that are painful) Head or Face Neck Shoulders Middle Back Lower Back Chest Arm or Elbow Wrist, Hand or Forearm Abdomen Front of Pelvis Hips or Thighs Knees Shins Ankle or Feet   * Describe the most painful area (use a 0-10 pain scale....0 being not painful 10 being excruciating)   * When did it start, and what makes it better and worse?   If there's a second area of complaint, describe it here (use 0-10 painscale)   When did it start, and what makes it better and worse?   The reason for treatment is due to a: Work Related Injury Automobile Accident Athletic Injury Progressive-No one injury Unknown   Describe any condition that may be related to your pain such as your general health   * Would you prefer our response to be by phone or e-mail phone e-mail   * Please leave your e-mail or phone number so we can respond.   Describe Treatments You Have Received and Medications That You Are Taking   * Do you have any of the following (if you don't know what it is, do not check the box): Aortic Aneurysm Spondylolisthesis Moderate to Severe Osteoporosis Pregnancy Lumbar Spinal Fusion or Metal Hardware Spinal or Pelvic Cancer A Recent Low Back Fracture Connective tissue disease such as Lupus, Rheumatoid Arthritis or Scleraderma I Don't Believe I have Any of These Conditions   Leave your address if you'd like information from a center closer to your home mailed to you.         Be sure to click "SUBMIT FORM" to send all your information to the doctors. We will respond to you within 24-48 hours.