Welcome Back Spinal Care Centres - Toronto
X-ray                       MRI                       CAT scan                       Bone Density
chiropractic                                   physiotherapy
massage therapy                         acupuncture
neck          low back          both
male          female
 
Please note this form will be emailed through your computer's default mail program (e.g. Outlook Express).  If you wish to just email an inquiry, please go back and press the email symbol.
Name:
Age:
Is your problem in the:
How long have you had your condition:
What other treatments have you had (check all that apply):
Check all conditions that you have or have had:
Have you had any of the following tests performed?
Any comments or questions?
generally good health
surgery - type
medication
other
spinal stenosis
osteoarthritis (degeneration)
disc bulge or herniation
sciatica
scoliosis
osteoporosis
cancer
other