To view this, you need to install the Flash Player 7. Please go here and download it.

Contact Us - FREE MRI Report Review

If you suffer from back or neck pain, have had a MRI, and are seeking the latest treatment methods, we would like to offer you a free MRI report review.

Through endoscopic back and neck hernia repair through the Deuk Laser Disc Repair™ procedure, we provide the world's most advanced surgical procedure to repair disc conditions of the spine. If you have been diagnosed with a herniated disc or other disc condition, and your physician has suggested spinal fusion surgery, a free MRI analysis by our medical team can help you determine whether the minimally invasive Deuk Laser Disc Repair™ procedure is right for you.

Submit the form below and a member of our Patient Services staff at Deuk Spine Institute will contact you to schedule your complimentary phone consultation. Or you can call Toll Free 24-hours per day, 365 days per year: 1-800-Fix-My-Back.


Patient Contact Information

* Indicates a required field

* First Name * Last Name * Street Address
* City * State * Zip * Country
* Phone Number Other Number * Best Time       * E-Mail

Your Back or Neck Pain

* 1. Where is your problem?
Neck
Arm or hand
Back
Leg or foot
* 2. How long have you had back or neck pain?
Less than 2 months
Greater than 2 months
* 3. Have you had a MRI or CT Scan of your back or neck in the last 6 months?
Yes
No
* 4. Area of Condition
Cervical (neck)
Thoracic (mid back)
Lumbar (lower back)
* 5. How bad does your pain get on a scale of 1-10?
6 or more
5 or less
* 6. Do you have pain shooting down your arm or leg?
Yes
No
* 7. Which arm or leg?
Right
Left
Both
* 8. Do you have weakness in your arm or hand, or leg or foot?
Yes
No
* 9. Do you have headaches?
Yes
No
* 10. What treatment have you had so far?
Therapy
Shots
Surgery
None
* 11. Do you have disc bulges or herniations on your MRI?
Yes
No
Don't know
* 12. Do you have spinal stenosis?
Yes
No
Don't know
* 13. Have you had an EMG and/or Nerve Conduction Study of your arms or legs?
Yes
No
* 14. Has surgery been recommended?
Fusion
Artificial disc
Laminectomy
Other
No
* 15. Is your problem related to an accident?
No
Work related
Motor vehicle accident
Slip and fall
Other
* 16. Do you have an attorney for this accident?
Yes
No
* 17. Your Gender
Male
Female
* Select Insurance Provider
Medicare
United Healthcare
BCBS
Cigna
Aetna
other Workers' Comp
Self insured company
Letter of Protection (attorney)
Self pay
Other
None
* How did you hear about Deuk Spine Institute?
* How can we help you?
FREE MRI Report Review
More information about Deuk Spine Institute and its services
Register for a Back in Motion™ Seminar
More information on Deuk Laser Disc Repair™
Speak to a medical professional about our treatments
Schedule an appointment
Travel package details on the 3-Day Transformation: Deuk Spinal Rejuvenation™
How to contribute to our research and education nonprofit organization, Deuk Spine Foundation
* Do you want Dr. Deuk to review your MRI images?

If you have an MRI on a DVD disk and the MRI is less than six months old, check ‘Yes’ and send the disk to Dr. Deuk for review (disks cannot be returned, so send a copy only):

 >> Dr. Deuk MRI Review
      Deuk Spine Institute
      6905 N. Wickham Road,Suite 201
      Melbourne, FL 32940
Yes
No
Do you have a specific question for the doctor?

I AGREE * Notice of Privacy and Limited Use: Any personal information you provide to Deuk Spine Institute in this form will not be used other than to contact you. We will not release your name, street address, telephone numbers or email address for third party use without your consent. By submitting your information you agree to receive future emails and correspondence from Deuk Spine Institute related to your care and spine health issues. You will have the option of being removed from our mailing lists.

Please understand that in performing a free MRI report review that: 1) Deuk Spine Institute is only providing an informal review of documents that you are providing; 2) that Deuk Spine Institute is not providing any treatment or form of diagnosis; and 3) that no doctor-patient relationship is established. Once we have reviewed your MRI report, we would be happy to schedule a consultation with one of our physicians in order to review all relevant medical records and your condition. Diagnostic and treatment recommendations can only be made to a patient of the Deuk Spine Institute practice after an appropriate medical interview and examination in person by one of our physicians.


 

Locations

Melbourne Location:

8043 Spyglass Hill Road, Melbourne, FL 32940
Tel: 321-255-6670
Fax: 321-242-2545
>>Map

Titusville Location:

836 Century Medical Drive Titusville, FL 32796
Tel: 321-383-8092
Fax: 321-383-1043
>>Map

Orlando Location:

6150 Metrowest Blvd, Suite 102
Orlando, FL 32835
>>Map