Stenum Hospital
patient area


If you would like to expedite the process, after submitting your form, please send via FedEx or DHL, copies of x-rays, MRI's medical reports and other info to;

International Dept.
Attn: Malte Petersen
Heilstaettenweg 1
Ganderkesee, Germany, 27777



or contact Jim Rider
1-866-544-8252
(pacific time zone)


Evaluation Form

Begin your evaluation and scheduling here.

To begin your evaluation process
complete the online form below and click "submit"
or send an email with this information to malte@karmaspine.com
Once you click "submit", wait........ it will take a few seconds to process.
Then, you should see more instructions and a link to
download and print our patient data sheet.
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For remote evaluation, please send (Fedex/DHL):
1. Recent MRI (within the last year, CD is OK)
2. X-rays (AP/lateral and extension/flexion views required)
3. Completed Patient Data Sheet
to International Dept.
Attn: Malte Petersen
Heilstaettenweg 1
Ganderkesee, Germany, 27777
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Copy these instructions now just in case!
Affiliate: getadr

  * Indicates a required field

Salutation
First Name *
Last Name
Sex Female Male
DOB Year Month Day
Height Ft. In.
Weight
E-mail *
Address
City
State
Country
Zip
Phone
Fax
Comments
  Please include, description of your pain, summary of any diagnosis or MRI reports, previous surgeries (type of procedure, levels treated), other medical conditions, etc..


Once you click "submit", wait........it will take a few seconds to process.
You should see more instructions and a link to download and print our patient data sheet.
Also, you will also recieve e-mails from our staff with more instructions.
Check your "junk e-mail" folder regularly!
Call Jim Rider (866) 544-8252, if you do not get your e-mails