[booked-calendar calendar=58] First Name * Last Name * Phone Number * Email * Primary point(s) of pain Low backNeckButtocksHip(s)Leg(s) If Other please specify: How long have you had the pain? Less than 4 weeksLess than 8 weeksLess than 6 monthsOver 1 year Describe pain (best as possible) DullBurningSharpTinglingNumbnessShootingThrobbing Frequency of pain Less than 4 hours/dayLess than 8 hours/dayConstant When is pain worst (e.g. night, activity, etc.) Have you been diagnosed with? SciaticaProlapsed discHerniated discDisc bulgeStenosisDisc degenerationSpondylolisthesisNone of them