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Screening Survey – Align Chiropractic Clinic Eastside

by | Jun 22, 2022

Displaying 1 - 25 of 188

NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
Nichole Lawsom08/26/2023Email hidden; Javascript is required.(573) 692-643301/01/201003:00 AM
  • Sinus/Allergies
  • Numbness/Tingling
Cody Jones06/29/2023Email hidden; Javascript is required.(573) 590-926706/30/202301:00 AM

He won’t be back until 7/10 but give him a call he needs in. He feel out of a tree stand 2 years ago and since then his hip shoots radiating pain down his leg

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
Morgan Voss06/29/2023Email hidden; Javascript is required.(573) 694-270506/29/202301:00 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
Morgan Voss06/29/2023Email hidden; Javascript is required.(573) 694-270506/29/202301:00 AM

Give a call in a few day

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
Ian MacLaughian06/26/2023Email hidden; Javascript is required.(573) 418-694806/26/202301:00 AM

Call and schedule

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain
Brian Hoskins06/26/2023Email hidden; Javascript is required.(573) 291-222606/26/202301:00 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
Debbie Wagner06/25/2023Email hidden; Javascript is required.(573) 694-849106/28/202312:00 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
Phyllis Brandt06/25/2023Email hidden; Javascript is required.(573) 694-147506/25/202301:00 AM

Foot

  • Hip/Leg Pain
Heidi Krause06/25/2023Email hidden; Javascript is required.(573) 619-749806/25/202301:00 AM

Goes to wheat

  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
Karley Frank06/25/2023Email hidden; Javascript is required.(573) 298-117806/25/202301:00 AM

Drives derby cars

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Gabby Scott06/25/2023Email hidden; Javascript is required.(573) 201-046306/27/202309:15 AM

Scoliosis

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
Denise Cross06/25/2023Email hidden; Javascript is required.(573) 644-342806/25/202301:00 AM

She sees one

  • Back Pain
Janay Heidbrink06/25/2023Email hidden; Javascript is required.(573) 645-083806/25/202301:00 AM

Scoliosis that she does nothing for
Call and follow up

  • Back Pain
  • Hip/Leg Pain
Connie Foust06/24/2023Email hidden; Javascript is required.(573) 220-498406/24/202301:00 AM

We are too far

  • Back Pain
  • Shoulder/Arm Pain
Mike Johnson06/23/2023Email hidden; Javascript is required.(573) 220-145806/23/202301:00 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
Angela Worsham06/23/2023Email hidden; Javascript is required.(573) 219-774806/23/202301:00 AM

Both hands tingling

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Adrian Nuse06/23/2023Email hidden; Javascript is required.(573) 632-302106/23/202301:00 AM

He is homeless and can’t make it to jeff

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Michael Dillingham06/22/2023Email hidden; Javascript is required.(314) 779-757606/27/202305:20 PM

3 shoulder surgeries rat shoulder

  • Back Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Mandy Stuckey06/22/2023Email hidden; Javascript is required.(573) 590-268006/21/202301:00 AM

Car accident about 3 years ago
C5 is disc is herniated
Call and get in

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Kenny Voss06/21/2023Email hidden; Javascript is required.(573) 298-208906/21/202301:00 AM

Muscle pain
Bad foot injury left foot
Broken pelvis left
Email to follow up

  • Sinus/Allergies
  • Hip/Leg Pain
Jordanna Mcleod06/21/2023Email hidden; Javascript is required.(417) 214-632606/21/202301:00 AM

Calf’s tighten
Might have
Call and schedule

  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Alyssa Rollins06/15/2023Email hidden; Javascript is required.(573) 690-396506/15/202301:00 AM

Is pregnant

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
Christine Grover06/15/2023Email hidden; Javascript is required.(573) 291-257606/15/202301:00 AM

Goes to kiazer

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
  • Shoulder/Arm Pain
Haley Logan06/15/2023Email hidden; Javascript is required.(573) 263-692206/19/202309:00 AM

Rat kidney removed

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
Trinity Williamson06/15/2023Email hidden; Javascript is required.(417) 770-542006/15/202301:00 AM
  • Back Pain
  • Hip/Leg Pain
NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 1 - 25 of 188