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Who We Are
The DISCSEELĀ® Procedure
Contact Us
DISCSEELĀ® News/PR
DISCSEELĀ® Corporate Team
The DISCSEELĀ® Procedure
Conditions Treated
Back (Lumbar)
Neck (Cervical)
Annulargram⢠Gallery
Success Stories
Find a Physician
Veteran Affairs
Clinical Studies
FAQs
Articles / Blog
Summary For Doctors
Become a DISCSEELĀ®
Physician
Research
Patents
Patient Resources
Information For Doctors
Find a Physician
Is the Discseel Procedure Right For You?
"
*
" indicates required fields
Step
1
of
5
- Medical Qualification
20%
Have you had an MRI within the past 12 months?
*
Yes
No
When was your most recent MRI?
Within 6 months
6-12 months
1+ years
Have you been diagnosed with any of the following?
*
Herniated disc
Degenerative disc disease
Sciatica
Chronic back/neck pain without a clear diagnosis
Other
Select All
Please specify
On a scale of 1ā10, how severe is your back/neck pain on most days?
*
Which activities are most affected by your pain?
*
Exercise/sports
Travel
Work productivity
Sleep
Playing with children/grandchildren
Other
Select All
Please specify
Which of the following best describes how your back pain affects your daily life?
*
Mild - I can still do most activities with discomfort
Moderate - I avoid or reduce some activities
Severe - I regularly cannot do important activities
DiscseelĀ® is not typically covered by insurance. Are you comfortable with self-pay for treatment?
*
Yes
No
Unsure
Multiple financing options available
Which of our treatment locations would be most convenient for you to travel to?
*
Arizona
California
Colorado
Florida
Illinois
Louisiana
Massachusetts
New Jersey
New York
North Carolina
Ohio
Oklahoma
Pennsylvania
Texas
Wisconsin
Japan
When are you hoping to address your back pain?
*
As soon as possible
Within 3 months
3ā6 months
6+ months
Full Name
Email
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
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Guam
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Iowa
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Maryland
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New Hampshire
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North Carolina
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Northern Mariana Islands
Ohio
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip
Anything else we should know?
Request a Free Discseel Procedure Evaluation
Name
(Required)
First Name
Last Name
Email Address
(Required)
Phone Number
(Required)
Where is your pain located?
(Required)
Choose option
Neck (Cervical)
Mid-back (Thoracic)
Lower back (Lumbar)
By submitting this form you agree that youāve read and consent to our Privacy Policy. We may use email, phone, or other electronic means to communicate with you. Most insurance plans do not cover the DiscseelĀ® Procedure at this time.
(Required)
I agree to the disclaimer.
By submitting this form you agree that youāve read and consent to our Privacy Policy. We may use email, phone, or other electronic means to communicate with you. Most insurance plans do not cover the DiscseelĀ® Procedure at this time.
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