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5834 S. 142nd Street Omaha, Nebraska 68137

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402-807-0121

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Do you suffer from neck or back pain, herniated or bulging disc, sciatica or scoliosis? Find out how you can avoid surgery and live drug-free with lasting relief from chronic and acute pain.

Age Range*

Where does it hurt?*

Describe the most painful area*

(Use a 0-10 pain scale...0 being not painful, 10 being excruciating)

When did it start and what makes it better and worse*

If there's a second area of complaint, describe it here*

(Use a 0-10 pain scale)

The reason for treatment is due to a:*

Describe any condition that may be related to your pain*

(Such as your general health)

Describe treatments you have received and medications that you are taking*

Do you have any of the following (If you don't know what it is, do not check the box)*

Aortic Aneurysm Spondylolisthesis Moderate to Severe Osteoporosis Pregnancy Lumbar Spinal Fusion or Metal Hadware Spinal or Pelvic Cancer A Recent Low Back Fracture Connective tissue disease like Lupus, Rheumatoid, Arthritis or Scieroderma I DON'T BELIEVE I HAVE ANY OF THESE CONDITIONS

How did your hear about us?*

Would you like to Schedule a Consultation with the Doctor?*

Yes No Possibly

call (402-807-0121) to arrange your FREE, consultation today! There’s no obligation and nothing to lose — but your pain!

Call Today!

402-807-0121

Request
Your Consultation

First Name

Last Name

Phone

Street

City

State

Zip Code

How did you hear about us? *

Would you like to schedule a consultation with the doctor?*

Would you like to schedule a consultation with the doctor? *

Yes No Possibly

Free Online Consultation

Visit Us

Call Today!

Free Online Consultation

Do you suffer from neck or back pain, herniated or bulging disc, sciatica or scoliosis? Find out how you can avoid surgery and live drug-free with lasting relief from chronic and acute pain.

Free Online Consultation

call (402-807-0121) to arrange your FREE, consultation today! There’s no obligation and nothing to lose — but your pain!

Call Today!

Request
Your Consultation

Spinal Balance Health Center

| All rights Reserved.

Free Online Consultation

Visit Us

Call Today!

Free Online Consultation

Do you suffer from neck or back pain, herniated or bulging disc, sciatica or scoliosis? Find out how you can avoid surgery and live drug-free with lasting relief from chronic and acute pain.

Free Online Consultation

call (402-807-0121) to arrange your FREE, consultation today! There’s no obligation and nothing to lose — but your pain!

Call Today!

RequestYour Consultation

Spinal Balance Health Center

| All rights Reserved.

Request
Your Consultation