Diagnosis Your Low Back Pain

GOT QUESTION? TEXT MESSAGE TO 801-987-0335

Diagnosis your Low Back PAIN.

Do you have a Budget for out of pocket health care costs or Wellness Care?

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Do you have a budget for Wellness Care *

Yes No

Name *

First

Last

Cell Phone Number *

Text message

How do you want to be contacted? *

Text Message Call

Have you had trauma to your Back?

Have you had trauma by falling, twisting or injury to Back *

Yes No I don't recall

Do you have any pain down the leg or numbness tingling in foot?

Pain in the back can create traveling pain down the leg *

Yes No I don't know

How would you rate your Back pain?

How would you rate your pain? *

1-3 3-4 5-6 7-8 8-9 10 Prefer not to say

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Click button below to contact Dr. Chase Gardner with questions about care & treatment options.

Call or Text Message
(801)-987-0335

Monday: 9:00-5:00
Tuesday: 9:00-5:00
Wednesday: 9:00-5:00
Thursday: 9:00- 5:00