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Spine Institute & Surgery Center

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Message to —Please choose an option—Richard Sayegh, DC, QME, CMUARostam Khoshsar, MDRobert Reisch, MDHarry Wurmsdobler, DC, QMEManasseh Nwaigwe, Jr., DCLaura Ho, DCTaed Setaghian, MDDaryll Sulindro, MD

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"I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form. By submitting my contact information including my telephone number or cellular number, I authorize S.M.A.R.T Spine Institute & Surgery Center and its affiliates to contact me via telephone calls and/or emails and/or text messages (SMS) to the residential or cellular phone number provided, using automated dialing technology for marketing/advertising purposes, even if that telephone number is on a corporate, state or national Do Not Call registry. No purchase required. Messages and data rates may apply."

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