candidacy-assessment Candidacy Check Tool Step 1: Tell Us About Your ConditionWhat condition do you have? Bulging Disc Degenerative Disc Disease Disc Tear Facet Joint Disease Failed Fusion Surgery Failed Surgery Syndrome Foraminal Stenosis Herniated Disc Pinched Nerve Radiculitis Radiculopathy Sciatica Spinal Bone Spurs Spinal Stenosis Spondylolisthesis Other Other condition:How old are you? 21 - 35 36 - 50 51 - 65 66+ How would you rate your overall health? Poor Fair Good Very Good Excellent Do you smoke cigarettes? No Occasionally Regularly Step 2: Tell Us About Your TreatmentHave you recently had any diagnostic exams? CT Scan Myelogram MRI Viscogram X-Ray How long ago was it taken? Not Applicable A month or less One to six months Seven months to a year More than a yearChoice Have you already undergone non-surgical treatments? Medication Chiropractor Acupuncture Physical therapy Nerve block injections Cortisone injections Other None Other treatments:Have you been recommended for surgery? Yes No If yes, how long ago? A month or less One to six months Seven months to a year More than a year Step 3: Get your resultsFirst Name* Last Name* Email* Phone*Insurance*Select your insurance typeAARPAetnaBeech StreetBlue Cross / Blue ShieldCaterpillarCignaCoventryHarvard PilgrimHumanaLiberty MutualUnited HealthcareMedicareOtherSelf PayOther Insurance*CommentsNameThis field is for validation purposes and should be left unchanged.
