In this section we ask some general questions about your illness. These answers will help our experts to understand your inquiry better. After submitting this form you will be redirectd to an upload form for files and medical images. You may leave this section empty and proceed to the "Submit" button below.
Please describe the beginning of you condition. How many weeks, months or years do you suffer already?
Please give us the clinical term(s) of your medical conditions
Is your condition work related, sports related, accident related, or age related?
Please describe your pain. Did the pain become worse quickly? Is it worse when you are walking? Do you feel pain while resting? Do you need pain medication? What gives you relieve (e.g. bending forward, sitting, lying down)
Avez-vous des engourdissements, des troubles sensitifs (paresthésies), des paralysies, une perte de la coordination, une faiblesse ou picotements dans la nuque, dans le dos, les bras, les jambes, les chevilles ou les pieds ?