If you wish to take advantage of the online consultation, please complete the questionnaire below, attach it to your scans and send to me direct in Munich.
Your name *
Your age *
Your e-mail 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? *
E-mail communication is not a secure connection. All data entered may be read by third parties. However, if you would like to communicate via email, please check the box. If you don't agree to this, you can print out this form and send it by post to my practice.