About SI Joint Pain
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Could your lower back or hip pain be caused by your SI joint?

Take the quiz to see if you should consider talking with
your doctor about the LinQ™ system to treat your pain.

Only a doctor can determine whether the SI joint is the source of lower back pain.
This quiz is not a substitute for a clinical diagnosis.

"*" indicates required fields

Step 1 of 3

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First Name*

First Name

Last Name*

Last Name

Email*

Email Address

Phone*

Phone

City*

City

State*

State

Zip Code*

Zip Code

Insurance Type*

Pain Management Provider

Do you identify as*

Male

Female

Q1. Where do you feel the most pain (Choose one area)?*

Lower Back

Hips

Buttocks

Q2. What is the level of pain you are experiencing?*

Occasional Pain

Moderate Recurring Pain

Intense Pain that Interferes with Daily Activities

Constant, Severe Pain

Q3. Does your pain interfere with your daily activities?*

Yes

Q4. Do you feel increased pain when: (check all that apply)

sleeping?

prolonged sitting?

walking or running?

bending over?

doing squats?

other exercises?

Q5. Have you had chiropractic care to address your pain?*

Yes

Q6. Have you ever received an SI joint injection or cortisone shot in your SI joint to address your pain?*

Yes

Q7. Have you been prescribed muscle relaxants, nonsteroidal anti-inflammatory drugs, or opioids to help relieve your pain?*

Yes

Q8. Have you experienced pain in your lower back, hip or buttocks during pregnancy or immediately after childbirth?*

Yes

Not Applicable

Q9. Have you ever fallen or experienced a traumatic injury to your lower back, sacrum or tailbone?*

Yes

Q10. Are one of your legs longer than the other?*

Yes

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4350 W Cypress St.
Suite 280
Tampa, FL 33607
(855) 248-7246

Distribution Center:
4017 Crescent Park Dr.
Riverview, FL 33578

NOTICE: LinQ may not be suitable for every patient, and individual results may vary.

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