Patient Intake Form

Interactive Patient Intake Form
The following is an interactive tool to provide Dr. Helper with key information regarding your current condition and medical history. Dr. Helper will then be able to formulate a leading diagnosis for your spine pain. Dr. Helper will personally respond to each intake form, providing you with the most likely diagnosis** for your spine problem, any necessary future investigations, and a probable treatment plan under his guidance.

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Please complete this form to the best of your abilities. If you are having any difficulties, feel free to contact Dr. Helper’s office at (604) 739-9695 for assistance.

One Comment

  1. Rana S.
    Posted March 20, 2011 at 4:50 pm | Permalink

    getting the run around in Victoria, BC with back and right hip pain ongoing for 7 years, but worsening over the last 3 years.DDD shown on MRI (private) however bone scan is not showing inflammation or reason for hip and back pain. X-rays negative also. Two cortisone injections to right hip with no benefit. Right leg weakness and have had 2 falls over past 6 months. Being shuffled through health care system, given multitude of pills which do not give any relief. Fighting with insurance company as no definitive diagnosis for past 8 months. blood test positive for anyklosing spondylitis. Are you able to assist me?

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