To expedite our communication to you, we request that you fill out the information below. After completing the information you will be granted access to download the Patient Information Questionnaire, including mailing instructions. This form can also be used if you have any questions and/or would like to receive additional information. If you have already had surgery and would like us to review your records, please send your operative reports along with the MRI scans, questionnaire and copy of your insurance card, front and back prior to scheduling your appointment. Information marked with an asterisk (*) must be completed so in the event there is an error with e-mail delivery, we are still able to respond to your question or comment.

The Wisconsin Chiari Center treats patients aged 15 years and older. Parents and guardians of younger patients are advised to contact a neurosurgeon at their local children's hospital.

Please provide the following contact information:

Loading... Loading...
You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.
The response has now been removed for the last question for which you selected a value. You may now enter a new response for that question and continue the survey.