Neck Patient Candidate Form

How do I know if I’m a good candidate?

Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here. Please note that we cannot give referrals for other facilities without knowing your case and that by completing our medical history and case intake form you understand that you are inquiring about being seen in our Florida center.

To have your case taken into consideration for our neck center, please complete the case intake form thoroughly and to the best of your ability. You can enter your answers directly into the pdf, save it, and upload it below- no printing and scanning required. However, if you prefer to print and scan it, you can upload it on this page when you’re ready or email it directly to info@caringmedical.com. You can also upload any pertinent medical reports, such as MRI or CT reports if you have already had those types of tests. A member of our neck team will get in touch with you during our next business day to acknowledge receipt of the completed form as well as any attachments. They will let you know what the next step would be based on the information you provide.

Thank you for considering the Hauser Neck Center at Caring Medical Florida! We look forward to learning about your case and getting to know you better. 

  1. Download the Hauser Neck Center patient case intake PDF by right-clicking on it and selecting “download linked file.”
  2. Fill out the form and save it.
  3. Upload your completed pdf using the form below. You may also include additional medical record files to upload at this time.

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    Fort Myers, FL 33908
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