(972) 432-7231
(972) 432-7231

Discseel Patient Application

Name(Required)
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Lower Back (Lumbar) - Please indicate where you are experiencing symptoms (check all that apply):

Lower Back
Legs
Feet
Toes

Neck (Cervical) - Please indicate where you are experiencing symptoms (check all that apply):

Neck
Arms
Hands
Fingers

Additional information

Please provide us with any additional details about about your condition or the surgical procedure you would like to avoid.
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