SPINAL CORD SOCIETY


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      All those interested are urged to participate now in the SCS Data and Referral System. If you are not now a candidate for a referral you may become one as more advances are made and will be notified. Also, by participating you are creating a demand and demand is what it takes to force progress in the medical system. So help yourself by getting into the Data and Referral files whether you are presently a candidate or not. You will receive a Medical Record form designed by doctors to be filled out by you and sent back to SCS. Your records will be entered into the SCS Data and Referral system and continuously screened as new treatments develop in every region of North America.

    All records are kept confidential and any used for purposes of statistical research will have all identification removed. To enter the database a fee of $50.00 for the form is required. Depending on the specified problem, (bladder problems, pain, paralysis etc.) SCS will then attempt, but cannot always guarantee, to make a successful referral to highly qualified physicians and medical centers.

Data and Referral System Application Form

NAME - Last_________________First__________________Middle________Date_________

ADDRESS____________________________________PHONE____(_____)______________

CITY________________________STATE_________ZIP____________________

______ Enclosed is a check for $50.00 for the Data and Referral Form.
Please send this application with check made out to: SCS
19051 County Highway 1, Fergus Falls, MN 56537-7609
(Please send a separate check for this form.)

I understand all my records will be kept confidential and that a
referral recommendation will be made only if physicians advise it.

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