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Three Days Post Discectomy Form

Dr. Ditsworth's Patient Only.
If you had surgery with another Dr, please use different form.

Please Fill out all fields.

It will help us provide better care if you answer the following questions 3 days after your procedure.
Name
Age
E-mail
Occupation
Today's Date(mm/dd/yy)
Date of percutaneous lumbar procedure(mm/dd/yy)
How was your trip home?
Describe any symptoms you have now - pain, numbness, weakness:
How are your symptoms different in comparison to prior to your procedure?
What medication are you taking and how often?
Are you having or have you arranged any physical therapy or traction (at home or at a therapy center?). Please Describe:
When are you planning to return to work?

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Symptoms
1.Sciatica;leg pain

2.Back Pain
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