Our Locations

Totowa | Oakhurst | Jersey City

Call Us

(973) 506-2304

Make Appointment

Home
About
- Dr. Tawfik
Conditions
Procedures
Our Locations
Contact

Home
About
- Dr. Tawfik
Conditions
Procedures
Our Locations
Contact

Home
About
- Dr. Tawfik
Conditions
Procedures
Our Locations
Contact

Make Appointment

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contact@medilab.com
(001) 1234 4321

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At Uprite Medical you’re not just another number. Our practice is tailored for each individual. We get to know our patients and treat them like family.

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Dr. Tawfik
Conditions
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Contact

Our Locations

Jersey City Spine Center
Oakhurst Spine Center
Totowa Spine Center
info@upritemedical.com
973-506-2304

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33%

Thank you for Trusting Us for your Second Opinion

Please provide your diagnosis or condition:(Required)

Herniated or Damaged disc

Sciatica or Pinched nerve

Spinal Stenosis

Degenerative Disc(s)

Bone Spurs

Spine Injury

Recommended for Minimally Invasive Procedure

Recommended for a Fusion

Recommended for an Artificial Disc

Other

If Other:(Required)

Have you been treated or had surgery for this condition before?(Required)

Yes

Please include a brief medical history, current treatment, or questions you may have for our team.

Your Contact Information:

First Name:(Required)

Last Name:(Required)

Email Address:(Required)

Phone:(Required)

History / Questions:

Name

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Step 1 of 3

33%

Let's Get Started on Helping You Learn About Treatment Options:

If Possible, please provide your diagnosis or condition:(Required)

Herniated or Damaged disc

Sciatica or Pinched nerve

Spinal Stenosis

Degenerative Disc(s)

Bone Spurs

Spine Injury

Other

Unknown

If Other:(Required)

Is there a specific treatment or surgery you want to know more about?

Yes, I would like to learn more about:(Required)

Please include a brief medical history, current treatment, or questions you may have for our team.

Your Contact Information:

First Name:(Required)

Last Name:(Required)

Email Address:(Required)

Phone:(Required)

History / Questions:

Comments

This field is for validation purposes and should be left unchanged.

Step 1 of 3

33%

Let's Get Started on Helping You Learn About Treatment Options:

If Possible, please provide your diagnosis or condition:(Required)

Herniated or Damaged disc

Sciatica or Pinched nerve

Spinal Stenosis

Degenerative Disc(s)

Bone Spurs

Spine Injury

Other

Unknown

If Other:(Required)

Is there a specific treatment or surgery you want to know more about?

Yes, I would like to learn more about:(Required)

Please include a brief medical history, current treatment, or questions you may have for our team.

Your Contact Information:

First Name:(Required)

Last Name:(Required)

Email Address:(Required)

Phone:(Required)

History / Questions:

Phone

This field is for validation purposes and should be left unchanged.

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Where is your pain located?

Neck

Upper Back

Mid Back

Lower Back

I am answering these questions for:

Myself

A relative or friend

Please select your gender.

Male

Female

How long have you been suffering from pain?

Less than a month

2-6 months

6-12 months

More than 12 months

On average, rate your pain level over the past 30 days:

Which treatments have you already tried?

(Select all that apply)

Epidural injections

Nerve ablation

Spine surgery

Spinal cord stimulation

Physical therapy

Chiropractic care

Home remedies

Other

None

What does your pain stop you from doing?

(Select all that apply)

Getting sleep

Working

Basic tasks around the house

Playing with kids or grandkids

Walking or shopping

Hobbies or other activities

None of the above

Get our recommendations for relief. We will email or text once our team can review your submission.

First Name(Required)

Last Name(Required)

Date of Birth:(Required)

Month

Day

Year

Phone(Required)

Email Address(Required)

Additional Comments?:

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Comments

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