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Screening Survey – Atchley Chiropractic Centers – Prosper

by | Aug 4, 2022

Displaying 26 - 50 of 81

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
02/12/2023Jose BarretoEmail hidden; Javascript is required.(787) 608-224702/14/202304:00 PM

2/14/74
P. E. Teacher in Princeton

  • Back Pain
02/12/2023Yashesh ParikhEmail hidden; Javascript is required.(312) 813-967403/13/202303:00 PM

Tailbone issue
5/14/76
Paid $20 Square

  • Back Pain
01/29/2023Maryam MirmohseniEmail hidden; Javascript is required.(573) 202-315902/01/202305:00 PM

5/22/81

  • Neck Pain
01/18/2023Stephanie KimballEmail hidden; Javascript is required.(214) 282-505802/10/202310:30 AM

8/25/66
Neighbors Nourishing Neighbors Director

  • Back Pain
01/18/2023Helene MortimerEmail hidden; Javascript is required.(571) 458-648501/19/202310:00 AM

2/18/72
Scoliosis
Neighbors Nourishing Neighbors volunteer
Paid $20 Square

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Sciatica
01/17/2023Holly MartinEmail hidden; Javascript is required.(217) 840-859902/16/202308:30 AM

2/23/80
West Plano Chapter

  • Back Pain
01/08/2023Mark WeisbruchEmail hidden; Javascript is required.(214) 287-831501/16/202309:45 AM

3/20/89
Legends Game
Paid $20 Square

  • Back Pain
01/08/2023Eric SmithEmail hidden; Javascript is required.(417) 818-446501/13/202308:00 AM

01/06/1995
Paid $20 Cash
Legends Game
Baseball coach / teacher at Emerson High School

  • Back Pain
12/15/2022Larry ReedEmail hidden; Javascript is required.(972) 742-771812/22/202203:30 PM

6/13/61
Paid $20 cash

  • Back Pain
12/15/2022Jackie BrownleeEmail hidden; Javascript is required.(214) 551-067112/19/202202:30 PM

3/10/1971
From Peaks Sports MGMT screening

  • Back Pain
12/14/2022Joseph KimbroughEmail hidden; Javascript is required.(469) 540-503101/09/202310:00 AM

10/30/93
Paid $20 Square
Legends Lunch

  • Back Pain
12/14/2022Jordan AcevedoEmail hidden; Javascript is required.(315) 408-612412/27/202209:30 AM

1/20/2013
Mom paid $98 Square for both appts

  • Back Pain
12/14/2022Jolene AcevedoEmail hidden; Javascript is required.(315) 408-612412/27/202209:30 AM

12/17/1984
Mother & Son appts
Paid $98 Square for appt and sons appt as well
Legends Lunch

  • Back Pain
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling
12/09/2022Denise CastilleEmail hidden; Javascript is required.(317) 514-282012/27/202210:45 AM

2/7/69
Paid $20 Square
Legends Game
Owner of AnyDay CPR

  • Back Pain
11/26/2022Jackeline ArevaloEmail hidden; Javascript is required.(469) 778-800611/30/202208:30 AM

8/20/2005
MVA on Nov 5th with mother
Mireira (mother) paid $20 Square for each appointment
Legends Game

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
11/26/2022Mireira EscobarEmail hidden; Javascript is required.(469) 778-800611/30/202208:30 AM

2/20/1981
MVA on Nov 5th with daughter
Paid $20 Square each for both appointments
Legends Game

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
11/21/2022Vinesh ReddyEmail hidden; Javascript is required.(909) 969-415411/22/202204:15 PM

6/17/72
Car wreck at 8 years old. Pain in feet when he walks
Paid $20 Square
Legends Game

  • Back Pain
11/15/2022Natalie FerraroEmail hidden; Javascript is required.(760) 610-938211/17/202209:00 AM

4/15/96
Paid $20 Square
Legends Breakfast
In Schedule

  • Back Pain
11/14/2022Jake DunnamEmail hidden; Javascript is required.(325) 450-403111/17/202205:00 PM

1/3/94
Paid $49 Square
Peak Sports MGMT
In Schedule

  • Back Pain
11/14/2022Sawyer CraigEmail hidden; Javascript is required.(903) 818-431911/16/202205:00 PM

9/14/97
Paid $49 Square
Peak Sports MGMT
In schedule

  • Back Pain
  • Numbness/Tingling
11/08/2022Jennifer HawkinsEmail hidden; Javascript is required.(469) 471-571011/10/202203:00 PM

5/13/1973
Paid $49
Lower back surgery few years ago. Herniated disc L5 and S1
Double mastectomy / chest pain

  • Back Pain
  • Hip/Leg Pain
11/08/2022Matt BellEmail hidden; Javascript is required.(817) 851-426211/09/202202:30 PM

6/29/94
Paid $49 Square
Boo Bash YMCA 10/29

  • Back Pain
11/07/2022Cory HamiltonEmail hidden; Javascript is required.(469) 588-626711/10/202204:30 PM

8/15/1976
Paid $20
Car Toys Frisco

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
11/07/2022Tracy MurphyEmail hidden; Javascript is required.(214) 934-355512/05/202208:00 AM

4/21/1964
Lena Smith’s Group/Grand Love

  • Back Pain
  • Neck Pain
11/07/2022Nicole TatangeloEmail hidden; Javascript is required.(214) 385-795511/11/202209:00 AM

6/15/1981
Paid $49 Square
Lena Smith’s Group/Grand Love

  • Neck Pain
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 26 - 50 of 81