Back pain treatment in 424 Neurosurgery, Orthopedic surgery, and Spine surgery clinics in Europe

Professional medical care, easy to book an appointment, good availability. However, the building is located in clear air zone, so you may be charged for driving. Also, the price for appointment was expensive.

a wonderful doctor who gave us a correct diagnosis after so many searches. we thank you from the bottom of our hearts and we will come back with great love. very kind staff

Great people, great quality of services. Went in for a clean-up and a consultation: Dr Boitos was very professional. The reception personnel is also great showing flexibility with rescheduling the appointments. Will definitely go back for the 6 months check up.

I would like to record all my gratitude to the pediatric team at Portland Hospital. My daughter underwent surgery and we were well taken care of. I want to give my special thanks to nurses Charity, Roberta and Priya, they were attentive and very affectionate with me and my daughter. Hospital food was surprisingly wonderful. Thank you to the whole team.

Great experience having a baby here and also a minor surgery post birth. We love the quality of care we always receive from the specialists, doctors and consultants we’ve worked with. Always wonderful.

We attended a hematology pediatric out patient appointment. We were pleased with all aspects of our daughters care. Especially the specialist knowledge and skills of the consultant. The speed at which we were seen was great- resulting in a positive impact on the whole families health. Thank you

I attended the Urgent Care Clinic at The Princess Grave hospital and I was blown away at the level of service offered. All the team, medical and support staff were outstanding. I was seen very quickly, issue addressed and I was discharged in less than an hour. It was excellent value for money for the service offered! Thank you.

I recently underwent a robotic prostatectomy at Princess Grace Hospital. From start to finish I had an excellent experience. The facilities, staff and expertise were of the highest competence and quality. All services were delivered with great empathy and care.

Fantastic hospital with exceptional staff throughout. Was nervous for my first surgery experience and I couldn't have been in a better place. The private room and provisions were comfortable. The food was of a very good standard. Staff were very attentive and strive to provide the highest level of service.

I have recently had a total hip replacement, carried out at the Wellington Hospital. I found the standard of care excellent at each stage, from the scan, to the pre admission meeting to my inpatient stay. The nursing staff were kind, supportive and friendly. My room was comfortable and the food was amazing,. Before I went I read the reviews on here and was surprised by the range of comments. I think some people have very unrealistic expectations of a hospital stay. This place is great!!!

I visited the Wellington for a scan and consultation. From the first meeting with the reception staff, everyone was extremely welcoming and helpful. The staff answered all my questions clearly and in the right amount of depth. I felt able to trust them immediately and my confidence grew as the process moved forward. I have no hesitation in recommending the Wellington as a first class centre for excellent healthcare

A phenomenal team that CARE deeply about their patients. Every visit to the Hospital….I am received with Love and dedication. Simply beautiful service. 😊 Thank you for your Love and kindness. ❤️

attended the one stop breast clinic, and cannot praise highly enough the whole experience was comfortable and professional from start to finishing the staff at every level were kind, caring, made me feel at ease and really eased my nerves. 10/10

Couldn't fault any of the staff for their professionalism, friendliness and reassuring manner they showed me during my short time with them. Everyone from the receptionist to the consultant were absolutely fantastic. Only one gripe I have is the limited parking on site. We were lucky to get a space but the alternative was a pay & display at a local supermarket. I find this a bit off considering the money I was paying for the treatment!!

The whole team at HCA Wilmslow are absolutely amazing. They quality of care and attention to detail is something I’ve never seen before. Special mention to nurse Rachel who was absolutely fabulous and took such good care of me both before and after my surgery.

I had a SPECT/CT scan and it was (virtually) painless and I was looked after briliantly. my only negative comment would bethat as there is a 3hour wait between the prep and the scan and the waiting room was not super comfortable for such a long wait,

Could not be in better hands. Had surgery under professor Andi Kavin and it could not go any better. Legend, absolutely professional and full of knowledge. The hospital team were exceptional. Margaret from the theatre (ICU) was exceptional too, her confidence and professionalism was second to none. Aldrin Reyes from the ward was also a true example of a real medical professional. I mentioned all these by names because sometimes it is easy to take for granted the little things that make a difference. A huge thanks guys.

Mr Petrou and the whole staff at the HSC were exceptional. The communication was awesome, the procedure faultless and the post-op care in the ICU and Cardiac ward were second to none. I felt my life was very safe in their professional and compassionate hands.

My Mom has just spent the last week at Parkside Hospital and I have nothing but praise for the hospital and staff. Special mention must be made of Sylvia and Eric, they are amazing. I found all the Staff very friendly and the hospital was lovely and clean, the food was great too. Thank you for making this week so pleasant for all of us.

I am feeling sorry that I am writing this review, but that's exactly how my care experience at Parkside suite was (September 2022). I must say that the single night I had to stay there after my surgery was the poorest care experience I ever had in my life, due to extremely rude nursing staff at the night. As I was shifted at Parkside, the nurse very rudely refused for my family to see me at all since the meeting time was just over. I understood the meeting time thing but shared with her that my husband had brought my three very worried, young kids to see me for 2 min, only because the Post Op nurse herself said they would be allowed to see me after I was shifted at Parkside 'as an exception' (reason because I was expected to go home after my day surgery but was admitted due to pain issue, so Post Op nurse said that this very short meeting would be allowed as an exception), however, the meeting never happened and my kids went back after waiting in the car parking for more than 1.5 hours. Well, at least I saw my husband who reassured the kids that I was fine. After my husband left, I asked the nurse how I could call someone if I needed anything, and she literally threw the bell on my bed. I was shocked!! and worried about spending remaining part of the night while facing such rude behaviour. Later on, when I requested the nurse if she could hold my hand for going to the toilet, she reluctantly did but asked me to hold the IV stand by myself with my other hand. I can't blv how being in the care profession a nurse couldn't understand how much pain a patient possibly can be in, literally within few hours after a surgery and still asking the patient to hold & drag the stand by themselves. All the night the two nurses kept making loud noise in the ward walkway, to the extent that it was hard to sleep at all. Every time, the nurse would come in my room and would take my BP and temp, waking me up but without speaking to me. None of the two nurses who I saw introduced themselves, I myself checked their names. None of the time, anyone asked me if I was in pain or if I needed any pain killer until I myself asked for a pain relief in the morning. The way I was treated made me feel that it was my fault that I was in pain and needed to stay there, so I had to tolerate the attitude. Never expected such an experience straight after a major surgery and while going through extreme pain. The next day staff were nice as well as caring, I got discharged in the evening next day and was so grateful that I didn't need to bear the same attitude again. Please improve the facility. A patient is already in so much pain and expects sympathy and care, not stares and rude attitude. Kind regards

I was an outpatient yesterday at parkside wexham. I just wanted to say how friendly I found everyone and the food was fantastic. The lasagne was the best I have ever tasted anywhere! My only minor complaint would be that I could hear another patient’s TV the whole time, but that would not stop me from highly recommending parkside.

I am feeling sorry that I am writing this review, but that's exactly how my care experience at Parkside - Wexham Park hospital was (September 2022). I must say that the single night I had to stay there after my surgery was the poorest care experience I ever had in my life, due to extremely rude nursing staff at the night. As I was shifted at Parkside, the nurse very rudely refused for my family to see me at all since the meeting time was just over. I understood the meeting time thing but shared with her that my husband had brought my three very worried, young kids to see me for 2 min, only because the Post Op nurse herself said they would be allowed to see me after I was shifted at Parkside 'as an exception' (reason because I was expected to go home after my day surgery but was admitted due to pain issue, so Post Op nurse said that this very short meeting would be allowed as an exception), however, the meeting never happened and my kids went back after waiting in the car parking for more than 1.5 hours. Well, at least I saw my husband who reassured the kids that I was fine. After my husband left, I asked the nurse how I could call someone if I needed anything, and she literally threw the bell on my bed. I was shocked!! and worried about spending remaining part of the night while facing such rude behaviour. Later on, when I requested the nurse if she could hold my hand for going to the toilet, she reluctantly did but asked me to hold the IV stand by myself with my other hand. I can't blv how being in the care profession a nurse couldn't understand how much pain a patient possibly can be in, literally within few hours after a surgery and still asking the patient to hold & drag the stand by themselves. All the night the two nurses kept making loud noise in the ward walkway, to the extent that it was hard to sleep at all. Every time, the nurse would come in my room and would take my BP and temp, waking me up but without speaking to me. None of the two nurses who I saw introduced themselves, I myself checked their names. None of the time, anyone asked me if I was in pain or if I needed any pain killer until I myself asked for a pain relief in the morning. The way I was treated made me feel that it was my fault that I was in pain and needed to stay there, so I had to tolerate the attitude. Never expected such an experience straight after a major surgery and while going through extreme pain. The next day staff were nice as well as caring, I got discharged in the evening next day and was so grateful that I didn't need to bear the same attitude again. Please improve the facility. A patient is already in so much pain and expects sympathy and care, not stares and rude attitude. Kind regards

Sadly our experience with Parkside so far has not been a positive one. My son's day surgery was cancelled 3 days before he was due to be admitted, with different staff giving different reasons. Not only are we disappointed at this, but we're also out of pocket due to the cancellation. A new surgery date is yet to be confirmed - again different staff have stated different things. Hopefully, if/when his surgery takes place I'll be able to change this to a more positive review.

Thank you to all of the wonderful staff at Parkside from every department each staff member I came across was friendly, approachable and I was treated with 5* service. Miss Burton, Mr Elkington and my anaesthetist Dr Justin Woods were so very professional, approachable and all had fantastic bedside manner. I am so pleased with the outcome from my surgery and more so the care I received during my stay it was above and beyond what I could have expected and would highly recommend my consultants and Parkside to future patients considering surgery.

My wife has had a shocking experience. She had surgery moved over 4 times, paying for services she never received and when complained was only offered partial payment as a ‘goodwill gesture’, yet over a month later, Spire continue to earn interest and withhold the funds. Their response after agreeing to partial payment is to ‘seek legal advice’. They do not value their patients at all and continue to ignore emails. Disgraceful service.

My dad had his total knee replacement on Saturday 21st October at Spire Bushey and I have many good things to say and some special thanks to certain people working there who made the experience a positive one. My dad was diagnosed with arthritis over 15 years ago and told he needs a knee replacement in his 50s, but he held out mainly due to fear and decided he would rather walk being reliant on just one leg then get the other replaced. Fast forward to present day where my dad is now 69 years old we then met Dr Paddy Subramanian - he was very positive, informative and honest and my dad felt very reassured and confident in him, as did I - I wanted by dad to be treated well and also believed Dr Paddy would take care of him and we decided to go ahead. Dr Paddy in fact saw us twice as my dad started getting nervous and needed some additional reassurance and Dr Paddy certainly gave us that second time round also. He was very generous with his time The day of surgery came and we arrived at Spire reception and were escorted by Gary Mullins who was a very friendly and kind gentleman and gave my very nervous dad reassurance. It was a comforting start to what was a very nervous day and the service Gary provided was much needed as he was the first person to start our day. This kindness and comfort continued and didn’t stop with Gary- the nurses Herald and Jessica who worked in the Lea Ward on Saturday 21 October 2023 made the whole time spent in room 35 so comforting. They were very very kind, professional, personable, reassuring and took such FANTASTIC care of my dad. Two of the best nurses we have ever come across. Every patient / hospital needs a Gary, Jessica and Herald - 3 people I imagine any patient would instantly feel better by To anyone nervous about knee replacement - don’t be if you’re getting it done by Dr Paddy. My dad was terrified of getting this knee replacement for years and as was I for him! We had all sorts of nightmares including of him waking up mid surgery and seeing/ hearing / feeling the procedure. I unfortunately can’t remember the anaesthetists name but he did a fantastic job at providing the perfect amount of sedation. Its very early days for him as it’s only 2 days after surgery and there’s a long rough road to recovery and lots of work to do day in day out but far more positive now. The knee replacement surgery itself is rough when you think about what they are actually doing - but the reality was that although that might be true, it turned out to be the best and most comfortable surgery experience my dad has ever had. He woke up from surgery in a pretty good state and far better then any of his previous surgeries My dad was in room 35 which was a lovely room. Very comfortable, nice room with a nice bathroom. The hospital itself was extremely clean and nice also. The food was great and whoever prepared the omelette and crème brûlée did a great job as my dad really enjoyed it Also additionally, the Spire Diagnostic centre is where my dad had to go before surgery during the lead up for his checks. This place also gave my dad reassure and confidence for the surgery because the diagnostic centre is extremely impressive - very state of the art and the staff also great. Unfortunately I don’t know the names of the staff that did his tests during his first pre op assessment there but they did a great job Earl was the final person we saw during our stay there, he was super kind and friendly and his kindness left its mark I am a very grateful daughter. We were so nervous before but now so thankful to all those mentioned in this review Thank you Dr Paddy & the team that were all there in theatre with him for your expert work, thank you Herald, Jessica, Garry, Earl, Kwasi , the physio team and Spire Hospital Thank you all very much! Please pass on my thanks to all those mentioned in this review

Unfortunately in June 2021 Spire Bushey Hospital almost killed me. I had an operation there with an over night stay and there was a complication after surgery that was completely missed by the nurses and doctors during my over night stay despite me showing clear symptoms from the moment I came out of surgery. I was rushed to an NHS A&E 1 day later after being discharged from Bushey Hospital with in severe septic shock needed an emergency operation and almost died this followed a very agonising 3 week stay in an NHS hospital. Then Spire did their own internal investigation and got that wrong. Firstly they sent me the wrong patients details so I actually had someone else’s information of another person who had complained. Then they stated that a complication was ruled out when it wasn’t and stated all my observations were normal which they weren’t. They said I was sipping fluids fine but never measured that I was given a black opaque jug of water which was changed far too regularly by the domestic staff so it definitely wasn’t measured. I raised a formal complaint with them which they have taken months and months and months to reply to and still have not responded despite me trying to chase the complaint. My surgeon at Bushey has been very helpful and told me he was very surprised that they did not even speak to him or approach him during their internal investigation so even he has found it shocking. You’re staff nearly killed me, they shared the opinions using confirmation bias to explain away clear symptoms of Spesis and there was not a NEWS score in sight. One nurse didn’t even know how to take a tympanic temperature (from the ear). The education of their staff post surgery is something they failed on their CQC report in January 2021 and it clearly put patients like me at serious risk. Please, please, please do you research when choosing a hospital for your operation because it’s so important to find a place with competent staff to look after you or your loved ones. Your life is at stake. EDIT: 03/10/23. I have responded to their message and emailed the address they have given. I have had no response.

It's early morning, 3.50 AM I lost my baby here .My bay was in 6 months, and everything was normal. It's only a lower belly pain and gas issue . Pain was completely gone after 24 hours. After 24 hours, my wife called me and told me I am feeling pain again and again with a 5-minute delay. And at 3.50 AM I listened we lost our baby 😢 Even the doctors don't inform me. I am the father of the baby , and I have the right to know each and every thing. Doctors took the 13 ultrasound in 2 days, and they are not able to access the main issue of this pain . All doctors were done ultrasound,blood, and urine tests separately. But they are not able to know what we should do for treatment. At night, there is no way to enter the hospital . Today, I am very helpless. Even I can't meet my wife. I can't see her condition. I can't go to her 😢....... When I enter in Gynecologist ward at 8 floor There was not any doctor near my wife. She left her alone and went somewhere else. My wife is crying 😢 for help. 3 old ladies in uniform seated near the door but don't call the doctor. When I ask about the doctor ,then after 20 minutes, she comes and starts arguing with me . Even there is no one in the main reception in the gynecologist section . What is this ........ I never ever heard or seen this neglegency. I am also a medical technologist. I never ever saw this condition in any hospital. This is not a hospital. It's a death cell. Not professional doctors and other staff ,they are killer . Even they don't give us our documents or medical history. How can they take our medical treatment history ?

Amazingly forthcoming and caring service every single time. All the staff is friendly and eager to help. I truly believe that any negative feedback partially has to do with who's leaving it.

My father in law is still here in intensive care. I have nothing but good things to say about the nurses and doctors working here. He's been here for two weeks now, so it's not a rash judgment. Update: after three months of intense fight for his life, my father in law lost the battle. I still stand by what I said, these people did everything humanly possible to cure him and ease his pain. I wish they worked in my city and that my family and I have people like these in our time of need.

Went in after falling, told nose was broken after MRI and sent out again without treatment. Few days later started falling again and couldn't walk. Called ambulance, 3 IV's at once. Bruises, infections, what I can only categorise as abuse as let's just say I have ties to hospital. Ended up needing private nurse when out to treat infections and damage they had done. These people should not be allowed treat tree's wouldn't insult animals.

From where the bolt driver dropped me off it looked like an old haunted building. When i entered, it looked like an abandoned mental hospital only missing a dead guy and a crazy dude in the corner. Asked two doctors walking around for help from which i got the answers "I don't speak english" in a perfect english accent and "No". Finally found a person that speaks english. After a minute or so she said that i have to go to a hospital 10 MIN AWAY WITH A CAR because this is not a childrens hospital. If you go here, do your research about where exactly you need to enter to get help and if you are younger than 18 years old do not go even near this hospital.

Came in for an emergency on a national holdiday at 6am, was greeted by very nice staff. Plus the overall experince was very professional. And despite the fact that I am deathly affraid of doctors and hospitals the staff did their best to make this experience more than bareable. Did not like the food but what do you expect from hospital.

I don't recommend it at all!, As several previous commenters did. It proves a deliberate deceptive and exploitative procedure that they collect the money in advance because they know that the person is sick, i.e. tired of the long wait in the crowd of non-paying patients, possibly covid or something else catching an infectious disease, he leaves them anyway. And of course the "kissers, friends" enter before you, even if they arrived after you!

I was completely satisfied with the service, everyone was kind and helpful from start to finish.

I have been struggling with my gall bladder for 9 years, neither in England nor at home, not a single hospital has undertaken my operation. Then they recommended this hospital. God bless the people who work here. Special thanks go to assistant professor Dr. Attila Paszt, who performed the surgery. It's a shame that I can only give 5 stars, because I wouldn't stop at 100.

I came to the hospital with a sharp pain in the ear, everything was alright at the start but after 1 hour my ear started hurting more and I started losing my hearing, after 3 hours I started crying because of the pain and they didn’t even care, they just walked past me and ignored, i honestly don't recommend this hospital to anyone, it is disrespectful to wait for a doctor for like 4-5 hours.

This wonderful place gets better every year. Some buildings get renovated, and some get built from scratch. Medical stuff gets multiple training to keep a professional and modern degree. Special thanks to @LizetePuga on tasty and beautiful food (children love those (and parents too)).

Huge hospital, based on long history. Enthusiastic and friendly personnel, despite long working hours. No doubt, there are a lot of things that could be better. But still - this is the best we have, and I'm proud there's BKUS in Latvia, Riga

I was under Mr Jay Smith and my total hip replacement went very well under his guidance and he has a very caring nature and always took time to explain how important the post care is. I found from the moment I entered the hospital, everyone was caring and service with a smile. Post surgery physios in the ward were excellent as well as after my discharge I was under the excellent care of Tighish, Senior Physio. She is absolutely brilliant and was very caring about my progress and making sure I was doing my exercises correctly. On discharge she made sure I knew how important the exercises were for my future progress.

Bishops Wood Hospital continues to provide an excellent service. A professional and friendly service was provided to me by Josephine in the Radiology Department. She was very efficient, made the mammogram as comfortable as possible for me and she checked regularly about how I was feeling.

I had surgery at bishops wood hospital everyone there was so friendly and polite. I had a nurse called Mihaela she was really friendly to me and we had a good laugh. before the surgery she made me feel less anxious. Mihaela looked after me well and so did the surgeons to.

Full professionalism.

This is the worst service 😒 the don't care about their clients, I came all the way from Italy to lithuania only for them to abandon me at the airport, their service is terrible 😑 and I regret having anything to do with that clinic 😢

Renata Petraityte is the Head of Sales for Western Market at Kardiolita Hospital, and Monika Palionė the Sales Manager for Western Market at Kardiolitos klinikos ... and they put 5 stars like customers !!!

It was a quite unfortunate choice to do a hair transplantation at Kardiolita Klinikos. They ask for photos of the current hairline and draw where you like the hairline to go. Then they quote you for the transplant. Problem is that they underdelivered quite extremely (see photos), yet they insisted on the full payment. They ignored my complaints and sent the case straight to a debt-collector agency. The consultation seemed quite sketchy in hindsight. They recommended a PRP treatment immediately the procedure. Research showed that it's effective only about a week prior to the procedure. Seemed like they just tried to upsell with no benefit for the treatment. I'd recommend to be very careful with this clinic or better find a clinic recommended by the various forum users on the internet.

Terrible rules of the clinic. Doctor applied treatment for my eye that was not working so i wasted ~80 eu + medicine. When i called to ask for a recipe for another medicine (cannot purchase without a recipe) they offerred to come to consultation again and pay +70 eu. I did not need a consultation i just needed another medicine. It would take 2 mins for doctor to issue new recipe but they refused to do so. I paid for the service that did not help, clinic rules should be more flexible and user friendly. Do not recommend. There are better clinics in Vilnius.

Was turned down as an international visitor with a medical issue (disk prolapse). Reception was unprofessional and unfriendly. I do not recommend this hospital if you need urgent assistance.

Would not reccomend. Staff is rude. After waiting for the doctor apoinment more then 40 minutes I did ask reception what is wrong. She called a doctor. Told me that there is family of 3 people and thats why they cannot take me on time. No aplogies, nothing. Neither they respect you, neither they respect your time. Did not ask me maybe I can visit other day or something. Nothing. Just canceled my apointment that I was waiting about a month. When you pay such money, you expect some kinda of good service

Radiation Scan and Analysis of Same. Was Superb. Dr Amir and staff incomparable.Assistant gave scrip for sleeping.

My story is for expats and foreigners in Moscow. Yesterday night my wife had a feeling of intense burning in her chest. She just recovered from covid (having made negative test that day). So, I took her to EMC to be faster than a state ambulance. We were at their premises at ca. 22:15. The place was not busy at this late hour. We explained our situation that we fear of heart attack or stroke. A receptionist first invited us to take a sit and wait for in-house emergency doctor. But then he realised that less than 14 days gone since first positive test. He told us urgently to leave the premises, saying that they can not help us in any way. He did not bother even to offer calling state ambulance. So, EMC pushed its patient, who might have had a life threatening condition, onto a street at midnight without any help. Beware, you should always have a plan B (and C) who you call in Moscow in such situations since evidently EMC can fail big time. Luckily for us we had other options, an ambulance from a competing private clinic arrived within 30 minutes and they helped my wife, so her life is not in danger anymore.

NOT RECOMMENDED. Visited the clinic for an emergency situation treatment. At the entrance a lady stops me asking are you aware of the fees. Minimum would be 165 euro then she says even for emergency cases we have to first fill up all the forms and formats, scan passports, take all data then we will listen to your problems. Upset about the service level given the prices. Big turn down. Also to add. I had been there after not finding a traumatolog doctor in their Arlovskaya clinic where the receptionist did same price detailing, holding me in pain at the gate and then says doctor needs time to be called even if emergency. Finally after suffering in both the EMC outlets I had to go to another local clinic. On the way in pain right now.

My son was treated here for a fractured arm. Dr Burstev did an incredible job both with the surgery and immaculately neat stitches, as with the care and attention given during follow-up appointments. Nurses and other staff also showed great attention and we really couldn't ask for more. Grateful.

Good specialists but expensive. Billed in EUR

Expensive company than a hosptial

I am a customer of the EMC for about 15 years. During the last 5 years the attitude of the hospital has changed. Before it was clearly the best place to get medical attention, especially when you are a foreigner and don't speak too much Russian. But now the game changed. Not only are they very high price and I most of the time I have the feeling that I am recommended additional check which are not needed. Now they also don't trust their customers any more. As a Foreigner, with a record in their database for 15 years, you have to prepay your treatment. I have always paid by bills with them before leaving the building on every visit, so I have not given any reason for this. And then the payment doesn't work well. The payment terminals are difficult to use / not working and the alternative is to go to the ground floor and pay at the cash register. For this money I expected perfect service. Don't get me wrong, I think the doctors are good. But the management I don't like.

Is it even legal to charge as much for health care? Seems like the regulator isn't aware of the price list of this hospital. Other than that having insurance isn't a guarantee that you'll get services in this hospital because there is lack of real time communication between the service provider and the insurance company, so you still have to guarantee payment with your bank card. If the two do not communicate in an hour, money is deducted from your card. Then back to square one...running after the insurance for compensation! Just a terrible experience to say the least.

Even after more than 25 years as a loyal customer, I was made to feel like a potential criminal who is lying about your insurance coverage. In the middle of a series of consultations and tests, I was forced to stand at the reception desk and have a lengthy discussion with the receptionist and the insurers before I could get the correct invoice with only 20 percent co-payment. This clinic is fine if you don’t mind being publicly humiliated and pay everything up front.