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Dr. Mohamed Osman, M.D
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On-Site Bloodwork
On-Site X-Ray
Pain Management
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Vein Care
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Patient Portal
Home
About
Staff
Dr. Mohamed Osman, M.D
Job Opportunities
Shop Supplements
Services
Allergy Testing
Assistance with Injuries
Athletic Recovery & Injury Prevention
Functional Medicine / Hormone Health
Hand Surgery
Injury Prevention and Athletic Recovery
IV Therapy
Joint Replacement
Lean Muscle Gain
MRI Review
On-Site Bloodwork
On-Site X-Ray
Pain Management
Physical Therapy
Podiatry and Podiatric Surgery
Primary Care
Spine Surgery
Sports Chiropractic
Sports Medicine
Surgical Sports Medicine
Vein Care
Weight Loss
Wellness
Treatments + Conditions
Patient Resources
Contact
Patient Portal
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Last Name
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Preferred Appointment Day?
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Appointment Time?
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Morning
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Reason for Visit (check all that apply)
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Sports Medicine
Athletic Recovery
Primary Care
Chiropractic Care
Foot and Ankle Care
Physical Therapy
Acupuncture
Flu Shot
Spine & Orthopedic Care
Pain Management - PRP, joint, epidural Injections
Regenerative Medicine, and Stem Cell Therapy , BMAC, Shockwave Therapy (EPAT), Peptides, NAD+
Neurology / Nerve Testing
Hormone Replacement Therapy (HRT), Testosterone, Menopause-related care & Peptides
IV Vitamin Therapy
Weight Loss & Wellness
Annual Adult Physicals
Athlete Readiness Exams & Preventive Health Physicals for Adults
Allergy & Immunology (environment and food testing)
Rheumatology / Autoimmune Care
Imaging & Diagnostics (X-ray / Diagnostic Imaging, EMG)
Laboratory Services & Blood Work (Preventive labs, Hormone panels, Autoimmune & inflammatory markers)
Occupational Therapy (OT)
Workers’ Compensation & Injury Care
Pre-Op / Post-Op Care Coordination
Medical Weight Loss (GLP-1s, Semaglutide, etc.)
Are you currently experiencing ANY of the following? (Check all that apply)
(Required)
Neck Pain
Low Back Pain
Mid Back Pain
Hip Pain
Knee Pain
Shoulder Pain
Elbow Pain
Wrist/Hand Pain
Foot/Ankle Pain
Sciatica / Radiating Pain
Muscle Spasms or Tightness
Weakness, Numbness, or Tingling
Headaches or Migraines
Joint Stiffness or Arthritis
I am not experiencing any pain or discomfort
Vein Health & Circulation Screening
Are you experiencing ANY of the following leg symptoms? (Check all that apply)
(Required)
Leg heaviness or fatigue (especially by the end of the day)
Aching, throbbing, or cramping in the legs
Swelling in the ankles, feet, or calves
Varicose veins (bulging, twisted veins)
Spider veins
Burning, itching, or tingling in the legs
Restless legs or leg cramps at night
Tightness, pressure, or numbness in the legs
Skin discoloration or darkening near the ankles
Skin thickening or dryness in the lower legs
Slow-healing wounds or sores on the legs or ankles
I am not experiencing leg symptoms
When do your leg symptoms feel worse?
(Required)
After long periods of standing
After sitting for long periods
At the end of the day
At night
During or after exercise
Symptoms improve when I elevate my legs
Not applicable
Do any of the following apply to you? (Check all that apply)
(Required)
Family history of varicose veins or vein disease
Job requires long hours of standing or sitting
History of pregnancy
Prior leg injury, surgery, or blood clot
Overweight or recent weight gain
History of swelling in the legs
I have been told I have circulation or vein issues
None of the above
How much do your leg symptoms affect your daily life?
(Required)
Mild – noticeable but manageable
Moderate – uncomfortable and distracting
Severe – limits activity, sleep, or work
Not applicable
Do any of these apply to you? (Check all that apply)
(Required)
Chronic joint pain lasting more than 3 weeks
Pain after a recent injury
Limited range of motion
Swelling or inflammation
Recurrent sprains or weakness
History of arthritis, tendonitis, or bursitis
Chronic fatigue
Unexplained weight gain
Hormonal or menopausal symptoms
Recurrent headaches or migraines
Autoimmune symptoms (rashes, elevated labs, etc.)
Prior epidurals, injections, or surgeries
None of the above
Where is your PRIMARY area of pain?
(Required)
Neck
Back
Mid Back
Hip
Knee
Shoulder
Foot/Ankle
Leg
Arm
Hand/Wrist
Head
Pelvic/SI Joint
Elbow
I have multiple areas
Not applicable
How severe is your pain today?
(Required)
0 = no pain, 10 = worst imaginable
Tell us more about your pain or symptoms
– When did it start? – What makes it better or worse? – Have you tried treatment already? – Any numbness, tingling, weakness, or instability?
How did you hear about us?
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Friend or Family Referral
Doctor / Healthcare Provider Referral
Google Search
Google Reviews
Social Media
Website
Walk-In / Passed By
Local Event / Community Event
Employer / Union
Insurance Company
Returning Patient
Other
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Insurance Name
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Consent
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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.
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Notes:
*In order to confirm an appointment, a patient advocate will reach out to you to gather your insurance information to verify your coverage and go over your benefits one-on-one.
**Please be aware this is an appointment request.
A doctor’s referral is not necessary to see our team for a consultation or to receive treatment.
We’re in Network with Medicare and Tricare. We work with all major medical carriers including the following:
Aetna, Cigna, UHC(United Health Care), NJ direct, BCBS/Anthem/Empire(Blue Cross Blue Shield), Amerihealth, Meritain
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