NY Spine Medicine
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Complimentary MRI Review by our physicians

NY Spine Medicine will review your current MRI, at no obligation, to determine which of our procedures will provide the most relief for your specific condition.

Within 24 hours of receiving your MRI results by fax, we will notify you via email, our physicianís specific recommendations

To receive your complimentary MRI review, fax or upload a current MRI report.

Please fax your MRI report to 212-750-1170 or upload a PDF copy in the form below.


COMPLIMENTARY MRI REVIEW FORM

First Name: *
Last Name: *
Address: *
City: *
State: *
Zip: *
Phone: *
Email: *
Please, describe your
condition briefly:
Symptoms:
Type of insurance: *
How did you learn about us?: *
Upload MRI report:
Upload more (max - 5):
Use this image to validate this form. *
Enter the security word shown to the left:

By filling out the MRI request form you acknowledge and agree that:

  • Your personal health information can be shared with employees of NY Spine Medicine
  • The MRI review is only an informational review of the documents that you are providing
  • The information provided by NY Spine Medicine is not a diagnosis. A diagnosis can only be made if you have been physically examined by one of NY Spine Medicineís physicians

NY Spine Medicine acknowledges and agrees that:

  • We will not share your personal health information to third parties without your written consent.