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Name
*
First
Last
Email
*
Phone Number
*
What symptoms are you experiencing?
Low back pain
Leg pain
Numbness or tingling in the legs
Heaviness or weakness in the legs
Difficulty standing or walking
Select all that apply
Do your symptoms improve with sitting or leaning forward
Yes
No
How long have you had these symptoms?
Less than 3 months
3–6 months
6–12 months
More than 1 year
Do your symptoms make it difficult to stand, walk, shop, or complete daily activities?
Yes
No
Sometimes
daily you you
Have you been told you have lumbar spinal stenosis or narrowing of the spine?
Yes
No
Not sure
Have you had a recent MRI or CT scan of your lower back?
Yes
No
Not sure
Submit