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Screening Survey – Atchley Chiropractic Centers – Castle Hills

by | Jun 9, 2022

Displaying 1 - 25 of 73

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
06/14/2022Tim HerterEmail hidden; Javascript is required.(469) 714-141306/21/202202:30 PM

12/13/1965

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
08/03/2022Teri TryonEmail hidden; Javascript is required.(469) 583-649008/04/202204:00 PM

Prosper Location
6/27/1962
Paid $49
Builders FirstSource Prosper

Her son has intense grand mal seizures

  • Back Pain
  • Neck Pain
08/04/2022Reggie WaddellEmail hidden; Javascript is required.(214) 277-338808/11/202209:30 AM

ACC - Prosper
11/14/1977
Paid $49
Verizon Prosper - manager

  • Back Pain
08/12/2022Beatrice CliftonEmail hidden; Javascript is required.(469) 381-028008/25/202205:00 PM

Screening - The Learning Experience - Castle Hills
Paid $20 cash
3/4/67

  • Back Pain
08/11/2022Giselle Burke HamiltonEmail hidden; Javascript is required.(816) 591-841408/27/202211:45 AM

Screening - The Learning Experience - Castle Hills
Paid $20 cash
9/21/85

  • Sinus/Allergies
08/11/2022Vannia BibolottiEmail hidden; Javascript is required.(469) 468-379908/22/202207:00 AM

Screening - The Learning Experience - Castle Hills
4/8/2000

MVA 2 years ago

  • Back Pain
  • Hip/Leg Pain
08/11/2022Cameron BrooksEmail hidden; Javascript is required.(469) 946-196308/22/202204:45 PM

Screening - The Learning Center - Castle Hills
Paying at appointment
5/24/88
Diagnosed with autoimmune disorder in 2014
Wife wants to come in for her appt at same time

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
08/11/2022Chelsea BrooksEmail hidden; Javascript is required.(318) 480-964008/22/202205:00 PM

Screening - The Learning Experience - Castle Hills
Paying at appt with husband
4/9/90

  • Sinus/Allergies
08/11/2022Morgan CauEmail hidden; Javascript is required.(682) 300-071109/30/202209:00 AM

Screening - The Learning Experience - Castle Hills
Paid $49 cash

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
09/17/2022Erica MingsEmail hidden; Javascript is required.(913) 961-391410/10/202210:00 AM

05/06/1987
Paid $20
Kidsgiving

  • Back Pain
09/17/2022Thorn SmithEmail hidden; Javascript is required.(512) 410-900409/26/202203:00 PM

7/27/1990
Paid $49
Kidsgiving

  • Back Pain
  • Hip/Leg Pain
09/20/2022Robert GarciaEmail hidden; Javascript is required.(469) 271-153710/05/202209:00 AM

12/2/1991
Paid $20 Cash
Fuzzy’s Taco Shop Carrollton

  • Back Pain
  • Neck Pain
09/21/2022Gary MorganEmail hidden; Javascript is required.(903) 815-474309/28/202210:45 AM

01/28/1952

  • Neck Pain
  • Shoulder/Arm Pain
09/22/2022Ethan BrunsEmail hidden; Javascript is required.(972) 998-187110/11/202209:00 AM

12/6/2019
Laura Bruns (mother)
Paid $49
Care Moore Initiative

  • Ear Aches
09/23/2022Nikki LewisEmail hidden; Javascript is required.(202) 769-410010/12/202210:30 AM

August 27, 1990

  • Back Pain
09/23/2022Chelsea OgletreeEmail hidden; Javascript is required.(214) 714-137510/03/202203:00 PM

4/14/1991

  • Back Pain
09/23/2022Jasmine DeweesEmail hidden; Javascript is required.(469) 744-510210/04/202202:30 PM

11/18/1966

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Sciatica
  • Shoulder/Arm Pain
09/23/2022Esmeralda BurberEmail hidden; Javascript is required.(214) 727-764010/04/202202:00 PM

10/23/1976
Paid $20

  • Back Pain
  • Disc Problems
  • Sciatica
09/23/2022Phillip MatthewsEmail hidden; Javascript is required.(214) 601-955810/06/202208:45 AM

2/27/1981

  • Back Pain
  • Sinus/Allergies
  • Shoulder/Arm Pain
09/23/2022Nachelle StuckerEmail hidden; Javascript is required.(469) 258-839610/01/202212:00 PM

2/16/1992
Paid $49

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
09/24/2022Amelia GrimesEmail hidden; Javascript is required.(903) 818-477509/29/202210:15 AM

1/7/1993
Paid $20

  • Sinus/Allergies
  • Ear Aches
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
09/24/2022Stacie BakerEmail hidden; Javascript is required.(585) 287-232011/04/202211:00 AM

9/6/1971
Paid $20

  • Back Pain
  • Neck Pain
  • Sciatica
09/23/2022Jakson VelasquezEmail hidden; Javascript is required.(214) 435-811710/04/202208:15 AM

Paid $49

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
09/23/2022Daniella PerezEmail hidden; Javascript is required.(469) 396-660409/23/202205:00 AM

Aug 31, 1990

Email with times

  • Back Pain
  • Shoulder/Arm Pain
09/24/2022Mary HendersonEmail hidden; Javascript is required.(971) 724-896910/05/202208:15 AM

7/18/1982
Can’t hear out of left ear
Doctor Atchley
Paid $49

  • Ear Aches
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 1 - 25 of 73