Email Marketing -

Become a Sports Medicine patient at PRISM Spine & Joint

Welcome to PRISM Spine & Joint. We are pleased you are interested in receiving care with us and look forward to helping you improve your health. We now offer specialized sports medicine care for athletes, hypermobile athletes, and dance medicine. Please complete the information below and we will reach out to you via email to schedule. We look forward to caring for you! Warmly, Dr. Zingman & the PRISM Team

Background Information

First Name

Last Name

Email*

Phone

City

State/Province

Date of Birth

Age

Medical/Injury information

Were you injured doing competitive or recreational physical activity?

Yes

No

What are your primary concerns?

Are you seeking specialized sports medicine care for any of the following?

Yes, I am a dancer/gymnast

Yes, I play a throwing sport and have a shoulder/elbow injury

Yes, I have generalized hypermobility and multiple injuries

Yes, I may have RED-S, Relative Energy Deficiency of Sport (ex: history of stress fractures, no longer menstruating if applicable)

Yes, I have a sport-specific injury not identified above

No, I have a non sport-specific injury

None of the above

Are you interested in being contacted for research studies as a potential research study participant?

yes

no

Financial Information

I understand that PRISM is out-of-network will all insurance companies and that I will be responsible for payment in full on the date of service.*

Yes, I agree.

No, please remove me from the waitlist.

I understand that if I cancel an appointment within 24 business hours of appointment, the full fee will be charged. Cancellation 25-48 business hours prior to appointment: 50% fee will be charged.*

Yes, I agree.

No, please remove me from the waitlist.