Dr. Robert A. Jarmain - Back/Neck Pain Clinic

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Contact Dr. Jarmain's Clinic

Call Now: 212-928-0900 Or submit the form below.

Just fill out the form below and click the Submit button at the bottom. An email will be sent to Dr. Jarmain and a copy to the email address that you provide.

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Personal Information

First Name:*

Last Name:*

Street Address:*

Add'l Address Info:

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Contact Information

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Your Pain History:

Is this the first time you are contacting Dr. Jarmain?

Yes No

How old are you?

Years

How long have you suffered with this spinal condition?

Years Months

Does the pain radiate from your neck into your arm and hand or from your lower back into one or both legs?

Neck Back Both Neither

Do you have numbness in your arms, legs, fingers or toes?

Yes No

Have you been treated by other health care providers such as PT, Chiropractors, Orthopedic, Neurologists, acupuncture, injections, and pain killers, etc., and the pain just will not go away?

Yes No

Do you have unbearable pain in your leg, which keeps you up at night?

Yes No

Do you have difficulty urinating, constipation or sexual disturbances?

Yes No

Does the pain stop you from enjoying daily activities?

Yes No

Have you been told you need Spinal Surgery?

Yes No

Choose your Gender.

Male Female

Area Of Condition.