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:
Insurance Company Name Type

We are the pre-eminent center in the world for Non-Traumatic Spine Procedure.

This procedure is totally non-traumatic access for removal of a bulging or herniated disc. This is the most advanced non-traumatic procedure available anywhere, beyond minimally invasive. We are the world leader in this procedure and it is not available at any other facility.


We have medical and surgical centers in Beverly Hills, Los Angeles with a staff of world-renowned surgeons, anesthesiologists, neuroradiologists, pain and rehabilitative specialists.

We have regional non-surgical centers in New York, Florida, and Illinois.

Contact Information:
National Phone Number:
800-956-6724
Beverly Hills:
Tel : 310-659-8498
Fax : 310-659-8869
Los Angeles:
Tel: 310-551-0690
920 S. Robertson Blvd.
Los Angeles, CA 90035
New York (New Patient contact):
Tel: 212-710-1339