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If you believe you could benefit from a consultation for minimally invasive spine surgery, we'd like to hear from you.

Contact LSI today to schedule your consultation at one of our consultation facilities.

Please complete the form below and submit. Within 2 business days, a patient coordinator will contact you in the manner and time in which you request.

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Personal Information
First Name:*	Last Name:*
Street Address:	City:*	State:
Address 2:	Zip:	Country:
Contact Information
Best Phone Number to Reach You* - - Ext.	Your Time Zone:
Other Phone Number to Reach You - - Ext.	Best Time to Call:
E-Mail:*	Confirm your E-Mail:*
Answer the Following Questions
Are you being represented by an attorney, or is your injury work related?*	YesNo
Have you been in pain more than 6 months?*	YesNo
Have you had a MRI or CTScan taken in the last 2 years?*	YesNo
Choose your Gender	MaleFemale
Area of Condition	LumbarThoracicCervical
Select your Insurance Provider*	Medicaid does not cover these procedures Select Private Company: Specify Other Insurance Type:
Select the type of Insurance	N/AHMOPPO
How did you hear about LSI?*	Which Internet Site?: Specify Other Internet Site: Which Print Ad?: Specify Other Print Ad: Who Referred You?:
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Notice of Limited Use: Any personal information you provide to LSI by this form will not be used other than to contact you. LSI will not release your name, street address, telephone numbers or email address for third party use without your consent.

** Please understand that in performing MRI reviews (a) that LSI is providing only an informational review of documents that you are providing, (b) that LSI is not providing any form of diagnosis.

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Toll Free hours are weekdays from 8:00am to 10:00pm EST

Laser Spine Institute makes the Inc. 500/5000 list for 2010!

In 2010, Inc. Magazine honored Laser Spine Institute with inclusion in its 500/5000 list of the fastest-growing, private companies as determined by number of employees and revenue growth over the last three years. Laser Spine Institute ranked No. 1,140 overall and No. 82 in the healthcare category.

Laser Spine Institute offers a successful alternative to traditional open back and neck surgeries and fusions.
The orthopedic surgeons at LSI can correct a variety of back and neck conditions through the use of minimally
invasive, endoscopic, outpatient procedures.

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Laser Spine Institute makes the Inc. 500/5000 list for 2010!

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