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Home > I Currently Have an SCS System > I Have a Permanent System > Share Your Story

Share Your Story

Has your life changed as a result of spinal cord stimulation surgery (SCS)? Let us use your story to inspire others. Complete the form below or call the ANS patient success story hotline at 866-945-PAIN (7246).

 
*  Indicates fields are required
 
*  First Name: 
*  Last Name: 
*  Address: 
*  City: 
*  State: 
*  Zip Code: 
If outside of US, please list Country: 
*  Preferred Phone Number: 
*  Email Address: 
Gender: 
Year of Birth: 
Previous surgery or device implant: 
Name of SCS Device: 
SCS Procedure Date: 
How has spinal cord stimulation changed your life?: 
Tell us about your condition - the cause of your pain, how long you have experienced pain, etc.: 
What advice would you give others who are currently experiencing chronic pain?: 
I want to submit a photo: 
 
 *  Yes, Power Over Your Pain Website and Advanced Neuromodulation Systems (ANS) can use my story. By checking this box, I understand and agree to give ANS Medical permission to use my story, photo and information on its website or any other marketing or promotional materials produced by ANS. I agree that my story is accurately written to the best of my ability. I agree and understand that ANS may edit content or contact me to learn more. All entries become the property of ANS.

To ensure your privacy, ANS will not sell or share your personal information with any third parties or outside mailing lists except as required by law or as stated in our Privacy Policy.