Doctor's Name: Practice Name: Hospital Affiliation: Contact Phone Number: Date of Exam:

1. What is my diagnosis?

2. What type of alternative therapies should/can I try?

3. How should I quantify my pain?

4. Will you put me on medications? If so, what are they and are there any side effects?

5. Will my insurance cover the treatments?

6. How often will I need to see you?

7. Is surgery possibly in my future?

8. What lifestyle changes, if any, will I need to make?

9. Who should I call in your office if I have more questions?

Thank you for visiting iScoliosis.com
Medtronic Sofamor Danek