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Call us:
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Hi! Thanks for contacting us. We would like to
collect some basic information
to be able to best help you.
This will take
less than 2 minutes.
Which of the following best describes
your situation?
Overview
I need a consultation for my cervical spine (neck)
I need a consultation for my lumbar spine (lower back)
I need a consultation for my cervical *and* lumbar spine
I need a follow up appointment
Where
would you like to be seen?
Location
(Required)
Los Angeles Office – In-Person Visit
Orange County Office – In-Person Visit
Virtual Visit via Video Conference
Have you had
previous
neck or lower back
surgery
?
Previous Surgery
(Required)
Yes
No
If yes...
Have you been
recommended to undergo
neck or lower back
surgery
?
(90% of patients with neck or lower back pain DON’T need surgery!)
Surgery Recommended
(Required)
Yes
No
This is my first time seeing a spine specialist
If yes...
Do you have a
recent MRI or CT scan
?
Recent Scan
(Required)
Yes
No
If yes...
What
kind of insurance
do you have?
Your insurance details allow us to verify your coverage in advance, ensuring a smoother appointment experience.
Insurance
Insurance Provider:
Medicare
Blue Cross PPO
Blue Shield PPO
Aetna PPO
Cigna PPO
United Healthcare PPO
Workers' Compensation
Self Pay
Please upload a photo of the front of your insurance card
Max. file size: 50 MB.
Please upload a photo of the back of your insurance card
Max. file size: 50 MB.
Almost done. We just need your
contact info
.
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First Name
(Required)
Last Name
(Required)
Cell Phone Number
(Required)
Email
(Required)
Your City, State, Country
(Required)
Your Date of Birth
(Required)
Additional info
Disclaimer
By clicking this box, you agree to receive SMS from Ehsan Saadat, M.D. Reply STOP to opt-out at any time, Reply HELP for customer care information. Message data rates may apply. Messaging frequency will vary
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