Your question to our back expert will be
addressed only if the answer is not already provided under the Back
FAQs, and you complete and submit the following form:
| Name |
E-Mail Address |
|
|
| Company |
Age |
Male |
Female |
|
|
|
|
| Height
ft inches |
Weight lbs. |
| Physical Activity Level: Intense Moderate Minimal |
What Kind of Activity?
(Please be as specific as possible) |
|
What Type of Work do you do?
(Please be as specific as possible) |
|
Your Question:
(Please be as specific as possible) |
|
| We need to have the following
information before we can properly address your question: |
| Have you had back pain on more than
one occasion? |
| Yes
No |
|
| If yes, please explain |
|
| Do You still have back pain? |
| Yes
No |
|
| If yes, please explain |
|
| Where is Your Back Pain? 1 2 3 4 |
|
|
|
| Do you do something to manage or
prevent your back pain from returning? |
| Yes No |
|
| If yes, please explain |
|
| Has a doctor or medical
practitioner diagnosed a spinal disease ? |
| Yes No |
|
| If yes, please explain |
|
| Have you ever had surgery on your
back? |
| Yes No |
|
| If yes, please explain |
|
| Have you Assessed Your Back
Function? |
| Yes No |
|
| If yes, please give your overall score |
|
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