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Screening Survey – Abundant Life Chiropractic Harrisonville

by | May 19, 2022

Displaying 1 - 24 of 24

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:Recently Experienced Symptoms:
07/29/2022Sean Hornbecksean.m.hornbeck@gmail.com(816) 721-693108/01/202204:15 PM
  • Back Pain
  • Back Pain
07/29/2022Sean Hornbecksean.m.hornbeck@gmail.com(816) 721-693108/01/202204:15 PM
  • Back Pain
  • Back Pain
07/30/2022Bobbi Keimwalkerchloe777@gmail.com(816) 605-098308/03/202203:30 PM

Scoliosis’

  • Back Pain
  • Neck Pain
  • Sciatica
  • Back Pain
  • Neck Pain
  • Sciatica
07/30/2022Jeremiah Niebuhrjeremiah.niebuhr@gmail.com(513) 535-709208/08/202202:30 PM
  • Back Pain
  • Sciatica
  • Shoulder/Arm Pain
  • Back Pain
  • Sciatica
  • Shoulder/Arm Pain
08/06/2022Ellie Mae Andersonlesliebray24@hotmail.com(816) 258-052908/10/202203:30 PM
  • Ear Aches
  • Ear Aches
08/09/2022Maustin Otterstattermotterstatter16@gmail.com(920) 904-654208/09/202201:10 PM
  • Back Pain
  • Hip/Leg Pain
  • Back Pain
  • Hip/Leg Pain
08/17/2022Becky Campbellbecky.campbell@harrisonvilleschools.org(816) 582-388708/29/202204:40 PM
  • Back Pain
  • Neck Pain
  • Numbness/Tingling
  • Back Pain
  • Neck Pain
  • Numbness/Tingling
08/17/2022Brandon Hordhord18@hotmail.com(816) 582-314509/06/202204:45 PM

Dr. Rebekah

  • Back Pain
  • Neck Pain
  • Back Pain
  • Neck Pain
08/18/2022Stacey Sandersstacygolfs@hotmail.com(816) 200-382708/23/202208:10 AM

Dr. Rebecca

  • Neck Pain
  • Neck Pain
08/18/2022Lisa Ehrhardtlilsfriend@yahoo.com(417) 540-100509/08/202204:45 PM

Dr. Rebecca

  • Back Pain
  • Back Pain
09/15/2022Shana Coppedgeshncoppedge@yahoo.com(816) 853-726409/20/202210:15 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
09/16/2022Garland Janse Claboughmjplumb17@gmail.com(660) 679-210010/03/202203:30 PM

Dr. Rebecca

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
09/17/2022Megan Vogtmrvogt3@gmail.com(618) 973-506309/21/202212:15 PM

Dr. Rebecca

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
09/24/2022Daniel Pinedanpine2018@gmail.com(816) 506-139109/29/202202:00 PM

Dr. Rebekah -Harrisonville

  • Back Pain
  • Back Pain
09/27/2022Test Testfrontdesk@chiroalc.com(816) 699-558210/12/202210:30 AM

Test

  • Back Pain
  • Back Pain
09/29/2022Test 2 Test 2abundantlifeharrisonville@gmail.com(913) 634-865609/29/202211:20 AM

Dr. Rebecca

  • Back Pain
  • Back Pain
09/29/2022Christina Fergusonbratina30@yahoo.com(816) 378-144010/05/202211:15 AM

Dr. Rebekah Paid $20

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
10/20/2022Sarah Underwoodunderwoodsarah22@gmail.com(816) 666-317110/26/202211:15 AM

Dr. Rebekah

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
10/21/2022Kathy Brownbrown.kathleen12@gmail.com(816) 806-048811/01/202209:00 AM

Dr. Rebekah

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Disc Problems
  • Sciatica
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Disc Problems
  • Sciatica
10/21/2022Test Test 10/25rachelle.hornbeck@gmail.com(913) 634-865610/25/202208:00 AM

Test Hville Health Fair

  • Back Pain
  • Back Pain
10/01/2022John Johnsonbig_johnson07811@hotmail.com(660) 351-583411/08/202204:30 AM

Dr. Rebekah

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Back Pain
  • Neck Pain
  • Headaches/Migraines
11/06/2022Robbie Reynoldsr.reynolds1816@yahoo.com(816) 591-846311/14/202202:50 PM

Dr. Rebekah

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
11/06/2022Lindsey Carterlindseyc326@gmail.com(816) 719-966111/10/202208:00 AM

Dr. Rebekah

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
11/06/2022Daniel Campbelldanielwcampbell@gmail.com(816) 582-096411/10/202210:40 AM

Dr. Rebekah

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Disc Problems
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Disc Problems
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:Recently Experienced Symptoms:

Displaying 1 - 24 of 24