EVALUATION

Would you like a second opinion utilizing a non-surgical approach of correcting scoliosis?

Have have you been previously diagnosed?

Are you or a loved one in the "wait and see" phase?

Are your concerned questions invasively answered?

Would you like to know on a personal level how scoliosis will affect you?

Would you like to know the symptoms of scoliosis and its effect on you personally in the future?



YOUR FIRST POSITIVE STEP TO RECOVERY IS THE EVALUATION

The Evaluation Report (narrative) is important because…

- It determines where you are now with your Scoliosis.
- What correction can be gained non-surgically?
- It qualifies you as a candidate for the Copes Dynamic Brace and program.

Please use the following as a checklist to ensure that you have everything needed for the evaluation. If ALL of the below material is not received on initial submission you will incur an additional charge of $25.00 ($50.00 for physicians).
In order to process your evaluation report in three (3) working days we will need ALL of the following information or the processing will be delayed!

___ Send (4) 14" x 36" X-rays (originals) for an evaluation.
(SEE ABOVE)
A. Standing AP (Full Spine)
B. Standing AP Bending Left (Full Spine)
C. Standing AP Bending Right (Full Spine)
D. Lateral View with left shoulder against the Buckie
(Full Spine)

Please contact us at 225-752-4912 to receive the two forms listed below or send email to bradc@scoliosis.com.

___ Complete in full the Confidential Information Form. You must sign & date this form!


___ Complete in full the Confidential Patient Medical History form.


___ FREE Evaluation includes:
Evaluation of your x-rays by our team.
Telephone consult as to answer your narrative results findings and any clinical bracing questions.
A written narrative report, including a biomechinal correction of curves and over view of possible treatment time.

You will need to verification your own insurance benefits and coverage.

A prescription for the Copes Dynamic scoliosis Brace and program is needed if you become a candidate by your Pediatrician and or G.P. and or Orthopedic doctor.

Use shipping companies such as UPS,or FedEx as one can track the package.


SEND X-RAYS TO:
ATTN:
A.B.S.
6630 Exchequer Dr.
Suite N
BATON ROUGE, LA 70809
(225)752-4912

X-RAY DATA INFORMATION
(Print and take this sheet with you for your x-ray appointment)

The following x-rays are the correct series for the evaluation:

Four (4) 14” x 36” X-Rays (originals)
Do not send copies - please keep copies for your files.

A. Standing AP (Full Spine)
B. Standing AP Bending (Left)
C. Standing AP Bending (Right)
D. Lateral View with left shoulder against the Buckie (Full Spine)


Helpful tips to having perfect x-rays:

· Do not take 14x17 films.

· While the bending x-rays are very important, please allow the neck and head to flow with the body and bending as far as possible. (Bending to a comfortable range.) Visualization from T-1 through sacrum is imperative.

X-Ray Technician Information
These factors are used in various doctors offices. Factors may vary according to your machine and patient size.



X-RAY FACTORS
X-RAY K.V M.A TIME

AP 86-90 200 6/10
Right Flexion 86-90 200 6/10
Left Flexion 86-90 200 6/10
Lateral 90 200 6/10