19 Harley St, London, W1G 9QJ, UK
We are London's Top Spine Clinic

New Consultation for low Back Pain including Sciatica

Please compete this form prior to your consultation.

The information will help in 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


Regarding you Back pain ;


Functional Assessment Score

  • This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life. Please answer by checking one box in each section for the statement which best applies to you. We realise you may consider that two or more statements in any one section apply, but please just select one that indicates the statement which most clearly describes your problem.

Roland Morris Disability Score


Visual Analogue Scores




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What we do...

The Harley Street Hospital


What is London spine unit and How it Works

The London Spine Unit was established in 2005 and has successfully treated over 5000 patients. All conditions are treated.

We treat all spinal disorders

The London Spine Unit specialises in Minimally Invasive Treatments allowing rapid recovery and return to normal function

Trusted by patients worldwide

The London Spine Unit provides the highest quality care to all patients and has VIP services for those seeking exceptional services

What our patients say about us ......