Home » Learn More » Educational Seminar on Back Pain » More Info

Saturday, October 11, 2008 - 10:00 AM

There are 6 seat(s) remaining for this seminar.

Laser Spine Institute
Doubletree Guest Suites Tampa Bay
3050 North Rocky Point Drive West
Tampa, FL 33607

To register for this free seminar, fill out the sign up form below OR call us at 866-DOCS-LSI (866-362-7574)

Complimentary refreshments will be served.

If you bring your most recent MRI films, CD, reports or CT scans to the seminar, you will have the opportunity to meet one-on-one with a physician. Please note that x-ray films are not acceptable to determine if you are a candidate for endoscopic spine surgery.

Fields marked with * are required

Personal Information
First Name:*	Last Name:*
Street Address:*	City:*	State:*
Address 2:	Zip:*	Country:*
Contact Information
Best Phone Number to Reach You* - - Ext.	Your Time Zone:
Other Phone Number to Reach You - - Ext.	Best Time to Call:*
E-Mail:*	Confirm your E-Mail:*
Answer the Following Questions
Select your Insurance Provider*	Medicaid does not cover these procedures Select Private Company: Specify Other Insurance Type:
Select the type of Insurance	N/AHMOPPO
How did you hear about LSI?*	Which Internet Site?: Specify Other Internet Site: Which Print Ad?: Specify Other Print Ad: Who Referred You?:
Will you be bringing your MRI FILMS, CD, reports or CT scans for our doctors to review?:	YesNo
How many people will be in your party, including yourself?*