New Patient Symptoms and Medical History Form

Prepare for your first visit at Mathur Spine Surgery

Mathur Spine Surgery provides a wide variety of orthopedic spine solutions for minor and major back issues. From general back and neck pain recommendations to stem cell injection therapy, Dr. Sameer Mathur is an expert in the field of orthopedic spine surgery and known by many in the Triangle region and beyond.

Part of the new patient process at Mathur Spine Surgery is to collect pertinent information for patients that are enlisting the medical services of the doctors and staff at Mathur Spine Surgery. To do so, we have all of our first-time patients fill out a New Patient Symptoms and Medical History form, which is provided below. At Mathur Spine Surgery we provide the highest quality spinal services and ensure our patients are treated with the best care. Filling out this form and entering in your symptoms and medical history saves time and helps us to begin thinking of a treatment plan more quickly.

S&A Spine First Visit

By filling out the New Patient Symptoms and Medical History form Dr. Mathur and his expert team will be able to assess your needs and give you the highest quality feedback to help take the next steps towards a life with less pain. Our services not only help relieve short term pain, but also set patients up with a better lifestyle to ensure they are staying healthy and as pain free as possible.

In order to assess and start the treatment process, prospective patients should schedule a consultation with Mathur Spine Surgery after filling out the form below.

Your symptoms and medical history are important for our team to review before conducting a consultation, therefore, please be as accurate and detailed as possible when sharing your information. The form covers basic patient information, chief complaints with associated symptoms, the date your symptoms started, specific back pain, a detailed pain rating, previous procedures/tests, your surgical history, social and family history, list of current medications, any and all allergies, and more. By filling out this form you are legally sharing your symptoms and medical background with Mathur Spine Surgery.

Please carefully fill out the form below with accurate information, to ensure we are up to date on all patient information.

If you have any questions or have trouble filling out the New Patient Symptoms and Medical History form, feel free to call our office Monday – Friday from 8:00 a.m. – 5:00 p.m. at (919) 297-0000 and a member of our experienced team would be more than happy to assist you.