Call Our Office:
419-775-9269
Appointments
Call Our Office:
419-775-9269
Appointments
Lower Back Pain
Lower Back Pain
Pain Assessment
Neck Pain
Symptoms and Causes of Neck Pain
Spinal Conditions
Spinal Treatment Options
Pain Assessment
Neck and Arm Pain
Carpel Tunnel Release
Carpal Tunnel
Our Practice
Meet Dr. Siegal
Patient Forms
Patient Resources
For Patients
Car Accident Specialist
Spinal Conditions
Spinal Treatment Options
Cutting Edge Technologies
Image Upload
Insurance Coverage
Prepare for Spine Surgery
Second Opinions
Spinal FAQs
Spine Glossary
Video Library
Key Clinics Blog
Pay My Bill
Contact Us
Galion Office
Mayfield Heights Office
Pay My Bill
Menu
MRI Review
Step 1: MRI Specifications & Details
What type of MRI do you have?
*
Cervical (neck) region
Thoracic (mid-spine) region
Lumbar (lower back) region
Hip, Buttocks, or Legs
Not Sure
How long ago did you receive your MRI?
*
0 to 6 months
6 months to 1 year
1 to 2 years
2 years or more
Where is your MRI report?
*
I have a physical copy
My imaging center has it on file.
I'm not sure
Step 2: Health Insurance Information
Select your primary state coverage
*
Select one...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
What type of insurance do you have?
*
Preferred Provider Organization (PPO)
Exclusive Provider Organization (EPO)
Health Maintenance Organization (HMO)
Personal Injury Protection (PIP)
Worker's Compensation
Medicare
Medicaid
Self Pay
Other or Unknown
Who is your primary insurance carrier?
*
Step 3: Get Your Free Review
Full Name
*
Email
*
Phone Number
*
Best Time to Contact You
*
Select one...
As soon as possible
Morning
Midday
Afternoon
Interested in Telehealth?
Select one...
Yes
No
Additional Comments or Questions?
CAPTCHA
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
