Survey Is Non-surgical Spinal Disc Decompression For You? Take this short survey to find out. Your Name (required) Your Email (required) What is Your Occupation? In Which Areas Are you Experiencing Pain? Lower Back Neck Hips Calf Foot Shoulder Upper Arm Lower Arm Wrist Hand Fingers Have You Experienced Any of the Following in the Last 6 Months? Headaches Dizziness Arm or Hand Pain Numbness and Tingling in Extremities Pain Between Shoulders Low Back Pain Pain Down the Legs Allergies or Asthma Painful and stiff joints Please Answer the Following Questions About the Pain You Are Experiencing. Do you believe that your pain is getting worse? Does your pain slow you down or stop you from performing daily activities? Does your pain cause you to take medication more often for pain? Does your pain cause you to miss work? Does your pain make you think about having surgery? Are you scared of the outcome of surgery? Please Describe The Frequency of Your Symptoms Intermittent | Occasional | Frequent | Constant Have You Ever Visited Any of the Following? Primary Doctor Neurologist Orthopedic Specialist Chiropractic Acupuncture Physical Therapist Massage Care Do You Have Access to Any Current Imaging? CAT ScanMRIXray Have You Ever Had Back Surgery?YesNo Have You Ever Had Neck Surgery?YesNo If you do qualify as a non-surgical disc decompression candidate and there was a way to help relieve your pain using one of our advanced non-surgical treatment programs, would you be willing to schedule a consultation? YesNo If so, When is the best time to contact you? MorningAfternoonEvening