Breakthrough Rapid Back Pain Relief Program in Bolingbrook, IL

📍454 West Boughton Road, Suite A

Bolingbrook, IL 60440

📞(331) 261-5465

Breakthrough Rapid Back Pain Relief Program in

Bolingbrook, IL

Check YOUR Eligibility

Who are you filling this out for? *

Myself

Other

What back pain symptoms are you experiencing? *

Sharp pain in the back

Trouble standing or sitting

Back muscle spasms

Pain when walking short distances

On a scale from 1-5, 5 being “excruciating”, how bad is the pain in your back? *

How long have these symptoms been bothering you? *

Less than 1 year

1 - 3 years

4 - 6 years

6+ years

Have you been told you're a candidate for surgery? *

Yes

Have you been diagnosed with any of the following conditions? *

Herniated disc

Degenerative disc disease

Sciatica

Stenosis

I don't know

Have you used opioids or steroid injections to mask the pain? *

Yes

I've had both

Financing options are available based on your credit. Which option best describes your credit history? *

Below 650

650-700

700-750

750+

Is 454 West Boughton Road, Suite A Bolingbrook, IL 60440 commutable for you? *

Yes

What is your Zip code? (this helps us know that we are reaching people in our area) *

Full Name *

What is your best email address? *

What is your best phone number? *

I agree to the terms & conditions provided by ProMed Pain Rehabilitation Institute, and by providing my phone number, I agree to receive text messages from ProMed Pain Rehabilitation Institute.