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Patient History Questionnaire
Patient Registration
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Video Clip: vau-02
Patient describes surgical and non-surgical options.
0:56 minutes / 660 kb

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Animation: 01
NEW! Epidural steroid injection:
This injection delivers anti-inflammatory medicine directly to the affected area to reduce the inflammation that may be irritating the nerve root. This animation gives you a close look at this common pain-relieving procedure.
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Forms

Patient History Questionnaire Patient Registration


For New Patients:


You may phone or visit our office from 8:30 AM to 5:00 PM Monday through Friday to schedule an appointment.

Please Call:
(925) 469-NCSI

Your First Visit

After you have scheduled your initial visit to NCSI, our staff will mail you a detailed questionnaire which needs to be completed prior to your arrival at the institute. Please complete this as accurately as possible, as this information will play an important role in your evaluation and treatment. The form is available using Acrobat Reader or a compatible program that reads pdf files. Download Acrobat
If you have problems opening the forms, see help page.

During your visit, the doctor will ask you about your medical history and your symptoms. You will also receive a physical examination of your spine. We will review your diagnostic studies, x-rays, CT or MRI scans that may have been obtained by your referring physician.

If additional test are required to assist in diagnois, we will order them at the conclusion of your visit. On completion of your visit your will be presented with a treatment plan. We strive to actively involve the patient in the treatment and decision making process.


** You can print the Patient History Questionnaire and complete with a blue or black pen, or type directly into the form in Acrobat Reader. Click on the line or box where you want to enter information and a cursor will appear or check boxes will be checked. You can also use the tab key to move from field to field. Save your form by clicking on the disk icon in the upper left hand corner of the Adobe frame. You may also choose Save As from the File menu. When you have completed filling out the form, print.

 

 



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