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Work Related Injury Patients

Treatment of work injuries can be challenging in terms of paperwork, approvals, work status and work return protocols. In addition to our expertise in managing such challenges, the minimally invasive spine surgery developed by Dr. Tannoury will offer you the best chance of early and full recovery.

To secure an appointment for a work-related injury, please complete the online form here or call Dr. Tannoury's office. We will be in contact with you within 24 hours.

IMPORTANT NOTE: Please make sure to bring with you to your appointment the CDs of all relevant previous studies, including x-rays, MRIs, and CT scans. While studies’ reports are helpful, they are not sufficient.

Are you an International or Domestic (U.S.) Patient?* DomesticInternational

Country of Residence*

Patient Information
First Name*	Last Name*
Phone Number*
Email*

Date of Injury (MM/DD/YY)	Date of Desired Visit

Purpose of Visit* First ConsultationSecond OpinionFollow Up VisitRequesting Information

In your own words, what you would like to achieve from this visit?


In your own words, please describe any previous surgery if applicable.


If you have any documentation to share with Dr. Tannoury prior to your visit, including x-rays, MRIs and CT scans, please upload them here. If you have multiple files to share, you will need to attach them using a single zip file. File Size: 5000KB Maximum

Case Manager Information (If known)
Case Manager First	Case Manager Last
Case Manager Email

Worker's Compensation YesNo
Occupational Health Provider	Insurance Name

Referring Healthcare Provider (if known)
Healthcare Provider Name
Healthcare Provider Email	Healthcare Provider Phone Number

Employer Information
Company Address 1	Company Address 2
City
State
Zipcode
Any additional employer contact information


Submit
* Required

Work Related Injury Patients

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