Patient Forms

To save time, print out and complete our new patient information form prior to your initial visit.

Jonathan Stieber Spine and Scoliosis Surgery New York NY Manhattan St. Luke’s-Roosevelt St. Luke’s Roosevelt Back and Neck Pain Minimally Invasive Surgery Disc Replacement Herniation Disc Replacement Adobe Reader Jonathan Stieber Spine and Scoliosis Surgery New York NY Manhattan St. Luke’s-Roosevelt St. Luke’s Roosevelt Back and Neck Pain Minimally Invasive Surgery Disc Replacement Herniation Disc Replacement

Please complete the appropriate surveys below as indicated by Dr. Stieber both before and after surgical treatment. These surveys are entirely confidential and are used for both ongoing research and to improve treatment.

 

General Spine Health Questions (All patients should answer these questions):

  

Questions for patients with neck and/or arm symptoms:

 

  

Questions for patients with low back and/or leg symptoms:

  

Questions for patients with scoliosis, kyphosis, or spinal instability:
Click Here to Take a Survey Click Here to Take a Survey Click Here to Take a Survey Click Here to Take a Survey

 
 

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