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Am I Eligible?

Clinical Assessment Form

Please complete the sections below.

A patient manager will contact you the next working day.

SpinePro is currently only able to assist patients who can self fund the treatment.

The purpose of this clinical assessment form is to determine suitability for Prodisc® L total lumbar disc replacement. The initial assessment is free of charge. An online consultation with a CCV surgeon to discuss specific cases and next steps costs £250.

Who Are You Enquiring For?

We work with MSK clinicians and other medical professionals across the UK and also accept enquiries directly from patients. SpinePro is currently only able to assist patients who can self fund the treatment.

Your Details Client Details

Sex

Background

How long have you been suffering?How long has your client been experiencing symptoms?
Have you been diagnosed with severe herniated or slipped discs?Has your client been diagnosed with a herniated or slipped disc?
Are you suffering with chronic sciatica and/or severe lower back pain?Does your client have chronic lower back pain and/or sciatica?
Do you have a recent MRI from within the last 12 months?Does your client have an MRI from within the last 12 months?
Are you ready for surgery to permanently resolve your symptoms?Is your client actively considering surgery?
Are you willing to travel to Montpellier, France? Your stay would typically be 9 days in total.Is your client able to travel to Montpellier, France? The stay is typically 9 days in total.
Treatment with SpinePro is privately funded. The complete package typically costs around £35k. Would this be within reach for you?Is the client aware that treatment is self-funded? (Typically £35k)

Your Symptoms Symptoms

  • Do you have pain in your legs (sciatica, cruralgia, neuralgia)?Does your client have leg pain (sciatica, cruralgia, neuralgia)?
    If yes, please tick the relevant areas in the diagram below:
    Body outline diagram Right Left
  • Do you have tingling or numbness in your legs?Does your client have tingling or numbness in the legs?
  • Do you have a significant loss of strength in your legs?Does your client have significant loss of strength in the legs?
  • Is the main pain...

Additional Information

By clicking submit, you consent to SpinePro sharing your personal data with CCV for diagnostic purposes based on information herein this website. Please see our Privacy Policy for further details of how we manage & use your personal data.

Am I Eligible?