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Screening Survey – Riggs Chiropractic – Riverton

by | May 20, 2022

Displaying 1 - 25 of 56

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
07/26/2022Becca DoBynsrdobyns@riggschiro.com(620) 249-901207/26/202202:30 PM
  • Back Pain
07/27/2022Tuesday Williamstuekellogg@gmail.com(417) 242-945508/09/202211:00 AM

Lbp, sharp pain in the middle, tailbone & hips - right one is so bad it becomes numb, left side neck pain, constant ear pain, injury long time ago in hips especially right, headaches-constant, lb & bottom numbness, shoulder arm pain-constant, does have fibromyalgia

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
07/28/2022Nathan Longoutback195@yahoo.com(620) 762-074007/28/202210:45 AM

Deg disc disease, lbp- sciatica- off to the right side, laminectemy

  • Back Pain
  • Sinus/Allergies
  • Sciatica
07/29/2022Austin Peaseaustinpease80@gmail.com(918) 961-017808/03/202204:00 PM

Lbp, excessive sinuses

  • Back Pain
  • Sinus/Allergies
07/29/2022Michayla Lawsonmichayla.lawson8@gmail.com(417) 540-686808/10/202210:00 AM

Hurts to breathe, mid back, both hips, headaches & migraines, left shoulder, torn labrum

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
08/02/2022Terry Shueyterryshuey@gmail.com(417) 529-915908/10/202209:00 AM

Headaches, right shoulder

  • Headaches/Migraines
  • Shoulder/Arm Pain
08/02/2022Jairo Laralarajairo3205@gmail.com(417) 396-557608/11/202209:00 AM
  • Hip/Leg Pain
08/09/2022Paul Mashburnbettymashburn@yahoo.com(918) 919-900108/11/202209:15 AM

Becca- Quapaw Fitness, reports no pain except for arthritis

  • Back Pain
08/11/2022Donna Barrettbarrettdonna@hotmail.com(417) 439-083408/18/202203:00 PM

Becca- Weston’s, Already paid like a long time ago, Right hip, knees, right shoulder

  • Hip/Leg Pain
  • Shoulder/Arm Pain
08/11/2022James Barrettlionhardt14@yahoo.com(417) 439-029508/17/202209:15 AM

Becca-Weston’s, pd-cash, 2/wk headaches, upper left back pain,

  • Back Pain
  • Headaches/Migraines
08/11/2022Robert Millsrdobyns@riggschiro.com(918) 541-334208/16/202209:00 AM

Becca- Weston’s, pd- cash, Lbp, sciatica left leg, numbness on that left side, right shoulder, right head pain behind ear,

  • Back Pain
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
08/12/2022Devon Ruddickdevonruddick@gmail.com(417) 629-205508/23/202209:15 AM

Lbp, right hip, headaches 4-7 per week,

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
08/12/2022Daniel Sharpdanirl.sharpie@gmail.com(417) 825-422708/18/202207:00 AM

Mid back pain, hip & leg pain right, numbness & tingling in neck on occasion, right shoulder (some from wreck 17 yrs ago) saw a chiro briefly then

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
08/12/2022Dalton Beckettlowwaternk@gmail.com(417) 317-909008/24/202209:00 AM

Lbp, neck pain, hip pain right, right shoulder, has been in several car accidents he said

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
08/12/2022Cameron Millercammiller411@gmail.com(620) 249-527508/22/202210:45 AM

Lbp, neck pain right side, right knee, right shoulder,

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
08/19/2022Lettie Hodgesladyinwc@yahoo.com(417) 438-842408/29/202202:45 PM

Right hip, neck-doesn’t have full range emotion, sinus headaches, osteoporosis, has had a spur and bulging disc at some point over the yrs, sciatica, has had surgery on right shoulder

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Sciatica
  • Shoulder/Arm Pain
08/19/2022Roy Hodgesladyinwc@gmail.com(417) 438-842408/30/202209:00 AM

Becca-Quapaw fm - pd clover for him and wife, Mid & lbp back, ran over by a tractor like 20 yrs ago, both shoulders operated on, recent(April) survey for cancer lump on his neck, numbness & tingling in extremities, sciatica, left shoulder since surgery,

  • Back Pain
  • Neck Pain
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
08/19/2022Jason Reevesrdobyns@riggschiro.com(918) 533-556208/24/202208:15 AM

Becca - Quapaw fm, hurts from shoulder blades down, neck pain everyday, left leg & hip, broke tibia twice, arms tingle sometimes- more the right one, shoulder right - torn ligaments 6/7 yrs ago,

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
08/25/2022Alex Newmanhardman.alex@yahoo.com(620) 210-414608/31/202202:45 PM

Becca-JBirds, lbp, numbness tingling in left elbow, headaches,

  • Back Pain
  • Headaches/Migraines
  • Numbness/Tingling
08/25/2022Deven Newmanhardman.alex@yahoo.com(620) 210-186609/08/202207:45 AM

Becca-JBirds, lbp, is missing a vertebrae - wife wasn’t sure which one,

  • Back Pain
08/31/2022Raven Wendlingraw43002@gmail.com(620) 249-328909/15/202202:30 PM

Whole back, left hip, 2/wk headaches,

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
09/06/2022Jeff Waryjeffwary@yahoo.com(620) 762-310209/14/202209:00 AM

Becca- Davis Real Estate cust. Appreciation, PD-clover, Pain from to shoulders to hips & knee, neck, right elbow pain

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
09/07/2022Cristy Hussongchussong75@gmail.com(620) 210-181609/15/202210:30 AM

Becca-JBirds, PD -CK#2227, HH-sent, Lbp radiates into stomach and into legs, 2/wk, num right arm,

  • Back Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
09/13/2022Kim Gentrykgentry57@yahoo.com(417) 291-626309/22/202209:45 AM

Becca-Weston’s: Shoulders, jaw pain, right shoulder, has been sick and throwing up a lot so lots of upper back pain right now,

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Shoulder/Arm Pain
09/13/2022Mark Gentrykgentry57@yahoo.com(417) 291-626309/22/202209:45 AM

Becca-Weston’s: mid back to shoulders, neck pain, neuropathy, left hip and leg, mentioned a compression fracture he had yrs back but not sure where, sciatica radiates to left side

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

Displaying 1 - 25 of 56