Select Page

Screening Survey – The Chiro Place – Bartlett

by | Jun 16, 2022

Displaying 1 - 25 of 76

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
07/20/2022Susie Quesusieq123@yahoo.com(901) 555-555507/21/202210:30 AM
  • Back Pain
  • Neck Pain
08/18/2022Steve Thomassmartone@gmail.com(901) 279-562408/23/202211:00 AM

Esporta AO

  • Back Pain
08/18/2022Hattie Shepardhattieshepard2012@gmail.com(901) 857-288308/30/202210:30 AM

Esporta AO

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
08/19/2022Tammy Williamsbabycalcal@yahoo.com(901) 212-446910/22/202209:00 AM

Northwest Prep AO
will pay at appt

  • Back Pain
08/19/2022Jeff Lappinjelap@hotmail.com(423) 208-870008/27/202209:00 AM

Northwest Prep AO
will pay at appt.

  • Back Pain
08/19/2022Yalonda Brooksyalondabrooks@yahoo.com(205) 335-981409/24/202210:30 AM

Northwest Prep AO
will pay at appt.

  • Back Pain
08/19/2022Jeff Lappinjelap@hotmail.com(423) 208-870008/27/202209:00 AM

Northwest Prep AO
will pay at appt.

  • Back Pain
  • Hip/Leg Pain
08/24/2022Tonya JonesRj864@bellsouth.net(901) 736-256808/29/202206:00 PM

Raleigh Love Day AO
Patient called 8/24 to set an appt
Will pay at clinic

  • Back Pain
08/25/2022Temeatria Maymeamay81@ymail.com(901) 490-478708/31/202204:00 PM

Agape AO
Will pay at appt

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Numbness/Tingling
09/03/2022Ronald Beckronald.beck@deximaging.com(901) 461-381209/06/202211:00 AM

Cleo T Hudson Memorial 5K AO

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
09/03/2022Marcus Johnsonmdj10ACTN@gmail.com(901) 240-382109/12/202206:00 PM

CTH5K AO

  • Back Pain
09/03/2022Donna Dossdjd38109@aol.com(901) 921-880709/08/202211:00 AM

CTH5K AO

  • Back Pain
  • Headaches/Migraines
  • Numbness/Tingling
09/13/2022Tammy Wadleytammyrwadley@yahoo.com(901) 530-799309/22/202206:00 PM

MLK Prep

Tingling in toes

  • Sinus/Allergies
  • Numbness/Tingling
09/13/2022Ladarrius Jonesladarriusjones59@yahoo.com(901) 596-831209/22/202206:00 PM

MLK Prep

Paid CASH

  • Back Pain
  • Neck Pain
09/13/2022Denise Crosssmcross04@gmail.com(901) 721-928409/29/202206:00 PM

MLK Prep

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
09/14/2022Deontae Walkerdeontae@ftkmemphis.com(404) 956-250209/19/202208:30 AM

For The Kingdom
Will pay at clinic

  • Neck Pain
  • Headaches/Migraines
09/15/2022Carrick Vanburenkochur920@gmail.com(815) 701-145610/06/202204:00 PM

Esporta

  • Back Pain
  • Neck Pain
  • Shoulder/Arm Pain
09/20/2022Jean Mottenjeanmotten@yahoo.com(901) 266-242609/27/202209:00 AM

50 plus Health Fair
PAID debit

  • Back Pain
  • Neck Pain
09/22/2022Courtney Brewercourtney.brewer45@yahoo.com(504) 638-833910/01/202210:30 AM

Z4 Razor Barbershop

  • Back Pain
09/22/2022Marzel RaglandZ4ragland@icloud.com(901) 293-495909/26/202209:00 AM

Z4 Razor Barbershop PAID

  • Back Pain
  • Neck Pain
  • Shoulder/Arm Pain
09/24/2022Treneka Jonestrenekajones@gmail.com(901) 618-565910/06/202206:00 PM

West side Elementary
Will pay with FSA

  • Back Pain
09/23/2022Elaine Rabyelaineraby1@bellsouth.net(901) 378-205810/06/202206:00 PM

West side Elementary

Paid debit

  • Back Pain
09/23/2022Elisha Williamsekobasuui@gmail.com(901) 503-573910/04/202206:00 PM

West side Elementary

Paid debit

  • Back Pain
09/23/2022Teresa Dawsondaw4459@aol.com(901) 277-846309/29/202206:00 PM

West side Elementary

Paid debit

  • Back Pain
09/28/2022Grace Alstongrace.alston9567@gmail.com(901) 502-151910/03/202210:30 AM

SCS Bonds Building
PAID Debit

  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 1 - 25 of 76