Back Institute is the pre-eminent center in the world for Non-Traumatic Spine Surgery. We are providing Non-Traumatic Spine Surgery the next level past minimally invasive spine surgery on herniated disc, treating sciatica and another kind of back pain. Back Institute has medical and surgical centers in New York, Beverly Hills, Los Angeles and Northern Europe with a staff of world-renowned surgeons, anesthesiologists, neuroradiologists, pain and rehabilitative specialists. Back Institute also has regional non-surgical centers in Florida, and Illinois.

Contact Information:
National Phone Number 800-956-6724
New York Tel: 212-710-1339
Email: info@nybackinstitute.com
5th Ave. New York, New York 10011
Beverly Hills Tel : 310-659-8498    Fax: 310-659-8869
Los Angeles Tel: 310-551-0690

 

Contact Information:
Name   * Email   *
City State
Phone Number Zip Code
Medical Information:
Are you the Patient?    If no, please tell us Yes.       If no,
Areas of Difficulty
Has patient had spine surgery? Yes No
What was done? When was it?
Who was the surgeon?
Do you have Back Pain? Yes No   |    Leg Numbness?Yes No
Neck Pain?Yes No    |    Leg Weakness?Yes No
Patient's Age   |   Patient's Sex years old         Male Female
Please tell us your exact symptoms:
(back pain? leg pain? weakness? numbness? exactly where)
Describe patient's problem
The problem started when?
Has patient had a scan? What did it show?
Has patient seen a surgeon for a present problem? What was recommended?
What tests and treatment has patient had?
What would you like to ask us?
Where did you hear about us

   If Others,

Other Information:
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