If you follow the link below it will take you automatically to the pain history form. Please fill in all questions conscientiously. If you have computed tomography (CT)or magnetic resonance tomography (MRI or MRT) findings please tell us about them or just send them as attachment (as jpg, pdf- or word file)..
NOTE: The findings and/or the report of findings should not be older than 3 months.
- Medical history form for the cervical spine
or - Medical history form for the lumbar spine
or - Questionnaire for the intervertebral disc prosthesis
You may send the anamnesis questionnaire as well as the radiological findings either via
fax 0049-(0)700-20 4000 20
or by mail to the attention of
APEX SPINE CENTER
Mrs. Vilma Vebaite
Dachauerstr. 124A
80637 Munich
or via
e-mail info@apex-spine.com
!! Please do not send us the original images or any CD ROMs !!
The filled in anamnesis questionnaire provides us with plenty of information on your spine disease and is hence extremely helpful for a precise diagnosis. Together with MRI findings a first diagnosis can be made before your first personal appointment at the APEX SPINE center and a possible treatment plan be generated.
The filled in form and the reports on diagnostic findings will be immediately forwarded to one of the physicians. If you mark your questionnaire as “urgent” your will get response the same day. Otherwise evaluation will be done within two to three days.
Please note the following:
The expert team of course is subject to professional secrecy. Your privacy is guaranteed at all times. Team APEX SPINE The Center issued to you only qualified evaluation or opinion on your symptoms and a recommendation to the other treatment options, based on the information you provided in the completed questionnaire. This can in no way be deemed a reference to the presence or absence of a particular disease or other ailment to be understood. Nor can the information provided or the information as a call to a specific treatment or no treatment of a possible disease are understood. The information given and information may, moreover, never call for self-treatment or self-diagnosis of a disease or other ailment can be understood as one.
All information and information are not binding and do not replace the medical advice and treatment. For the correctness and completeness of the information, any liability excluded. Likewise, for transmission on the Internet not to be taken for errors. There will be an administrational fee for this evaluation of about approximately 70.-€..
