Online Consultation

If you wish to take advantage of the online consultation, please complete the questionnaire below, attach it to your scans and send it to Jon Wilkie or to me direct in Munich.

 

Your name *

Your age *

Your e-mal address *

Your telephone number

Your address *

Since when do you have pain and where? *

Do you blame any event for these complaints (e.g. accident, heavy lifting..) *

In which position your complaints are worst? (lying down, sitting, standing, walking?) *

By which actions do you get relief? (e.g. bending forward, sitting..) *

Do you experience pins and needles or numbness, temporarily or continuous? *

Do you have a restriction in motion range, loss of strength? *

Have you got images? Which ones? When? Result? *

Which diagnoses have been established up to now? *

Have you been operated upon already or is operation recommended? *

Additional remarks

* Mandatory item

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