19 Harley St, London, W1G 9QJ, UK

New Consultation for Neck Pain including Brachialgia

Home → New Consultation for Neck Pain including Brachialgia

Please complete this form prior to your consultation.

The information will help us in determining a diagnosis and treatment.

Please note that all information is kept strictly confidential and will not be disclosed to any third parties.

Personal Details

Name *
Address *
Contact Phone *
Email *
Who referred you to us ie GP, Therapist, Friend ?

Regarding you Neck pain ;

Is it worse on one side of the spine ? *
Does your neck feel stiff in the mornings but gets better after a while ?
Is the pain worse at the end of the day or when you sit for long periods in front of a computer ? ?
Is pain is worse after impact sports such as tennis or football ?
Does pain refer into one or both arms below the shoulders ?
Is there weakness in one or both arms ?
Is there numbness in one or both arms ?
How long have you had these symptoms *
Is pain is better when you lie down ?
Do you have any problems in controlling bowels or urine ? *

Functional Assessment Score

Neck Disability Questionnaire This questionnaire has been designed to give us information about the severity of your neck pain. Please answer every question by selecting the answer that best describes your condition today. We realise you may feel that two of the statements may describe your condition, but please select only the single answer which most closely describes your current condition.
Section 1 - Pain Intensity *
Section 2 – Personal Care (Washing, dressing, etc.)
Section 3 – Lifting *
Section 4 – Reading *
Section 5 – Headache *
Concentration *
Work *
Driving *
Sleeping *
Recreation *

Visual Analogue Scores

Pain Intensity - Please estimate how intense your pain is now
Average pain intensity - please estimate your average pain over the last week
Distress-Estimate how distressing your problem has been over last week:
Coping-Please estimate how confident you feel at coping witha flare up

Verification

Please enter two digits with no spaces (Example: 12) *
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Specialist Doctors

Mr. Mo Akmal MD FRCS

Consultant Spinal Surgeon

Specialist in Minimally Invasive Spinal Surgery and Medical Director of The Spine Unit

Mr. Mo Ahmed FRCS

Consultant Spinal Surgeon

Specialist in Spinal Surgery and previously worked as a consultant in Norway

Mr. Ahmed Hussien FRCS

Consultant Spinal Surgeon

Specialist in Neurological disorders affecting the spine. Treats spinal cord problems.

Mr. Reza Mobasheri FRCS

Consultant Spinal Surgeon

Specialist in Spinal Surgery

Mr. Masood Shafafy FRCS

Consultant Spinal Surgeon

Specialist in Spinal Deformity Surgery.

Dr Nathalie Courtois FRCA

Consultant Spinal Anaesthetist

Specialist in Anaesthesia for Spinal Surgery.

What our patients say ...

Lumbar Decompression and Instrumented Fusion for Degenerate Lumbar Disc

I felt extremely comfortable, confident and un-pressured from start to finish and had a clear understanding of the details of diagnosis and relevant procedures that

Vertebroplasty for treatment of Vertebral Compression Fracture

I was in great pain and needed help immediately and I was delighted my problem could be dealt with quickly. Mrs Coral K

Carpal Tunnel Release in the Cervical Spine

The service Mr Akmal gave me was exceptional. I am absolutely satisfied with all the staff at St. John and St. Elizabeth and especially with

Treatments

Advanced Disc Solutions

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Spine Ozone Therapy

Advanced Pain Management

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Endoscopic Camera Assisted

Keyhole spinal surgery

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This surgical technique consists of a percutaneous approach for the treatment of small to medium size hernias of the intervertebral disc by laser energy. The main objective is to reduce the intradiscal pressure in the nucleus pulposus