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Screening Survey – Atchley Chiropractic Centers – Prosper

by | Aug 4, 2022

Displaying 51 - 75 of 81

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
11/05/2022Hondo SalgadoEmail hidden; Javascript is required.(214) 458-206211/21/202210:00 AM

8/26/1974
Paid $49
Nerve issues in right hand
Bone spurs off of vertebrae

  • Numbness/Tingling
11/04/2022Luis PuentesEmail hidden; Javascript is required.(214) 400-760511/11/202211:00 AM

10/18/1993
Paid $20 Square

  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
11/04/2022Hector QuintanaEmail hidden; Javascript is required.(972) 505-689311/09/202212:30 PM

10/13/1999
$20 cash

  • Shoulder/Arm Pain
11/04/2022Ada GalvanEmail hidden; Javascript is required.(214) 425-617311/09/202211:30 AM

7/21/1973
Paid $49 Cash

  • Back Pain
  • Neck Pain
  • Shoulder/Arm Pain
10/29/2022Chase KruegerEmail hidden; Javascript is required.(405) 227-351811/02/202201:30 PM

07/17/89
Paid $49
Prosper
YMCA BOO BASH

  • Back Pain
  • Hip/Leg Pain
10/28/2022Alex ZavalaEmail hidden; Javascript is required.(469) 815-105211/28/202207:00 AM

Possible preventative care
Very healthy scan
Reach out in two weeks
Born 04

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
10/28/2022Justin DoanEmail hidden; Javascript is required.(720) 936-979710/31/202207:00 AM

Sees chiropractor already
Reach out in two weeks
Open about getting second opinion

  • Back Pain
  • Neck Pain
  • Sciatica
10/28/2022Alex MundoEmail hidden; Javascript is required.(631) 617-410510/31/202212:45 AM

9/21/92
Paid $20

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain
10/28/2022Olivia FletcherEmail hidden; Javascript is required.(214) 394-945111/03/202205:00 PM

03/04/03
Left shoulder constant popping and pain
Double jointed
Paid $49 Square (2:12)

  • Back Pain
  • Shoulder/Arm Pain
10/28/2022Erich EhleEmail hidden; Javascript is required.(469) 600-805510/31/202207:00 AM

5/16/85
Reach out for appt in 2 weeks
Available after Dec 15th

  • Neck Pain
  • Headaches/Migraines
10/28/2022Stacy ThomasEmail hidden; Javascript is required.(469) 469-404810/31/202207:00 AM

12/18/85
Looking for 7am appt.
Call in a couple days

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
10/28/2022Bernard WalkerEmail hidden; Javascript is required.(214) 924-964211/07/202207:00 AM

Consult only…no exam
4/16/73

  • Back Pain
10/28/2022Mike DentonEmail hidden; Javascript is required.(405) 313-539411/01/202207:15 AM

Paid $49 Square (12:55)
01/24/1994

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
09/12/2022Robert 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
09/12/2022Joyce ParhamEmail hidden; Javascript is required.(469) 826-840509/22/202204:00 PM

7/10/1987
Paid $ 20 Square

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
09/12/2022Paige RowleyEmail hidden; Javascript is required.(214) 422-639209/20/202207:30 AM

10/16/1998
Paying 9/16

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
09/12/2022Chelsea LoomisEmail hidden; Javascript is required.(386) 289-030609/16/202207:30 AM

10/28/1983
$20 Square

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
  • Shoulder/Arm Pain
09/12/2022Fatima SanaiEmail hidden; Javascript is required.(972) 522-865809/15/202209:00 AM

8/13/1983
Paid $49 Square
Owner of Kiddie Academy Prosper

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
09/12/2022Usha sri PappuEmail hidden; Javascript is required.(925) 786-359909/14/202204:00 PM

2/25/1970
Tennis elbow
Pay in office

  • Back Pain
  • Sinus/Allergies
  • Ear Aches
09/12/2022Cassie ThorntonEmail hidden; Javascript is required.(859) 669-907709/13/202208:00 AM

3/30/04
Paid $49 Square
MVA - 3 years ago

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
09/12/2022Gabrielle MerilattEmail hidden; Javascript is required.(972) 370-798109/13/202202:30 PM

8/19/04
$25 cash

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
09/10/2022Chris BrownEmail hidden; Javascript is required.(214) 883-772309/16/202211:00 AM

5/3/83
Sam Johnson Elementary
Paid $20

  • Back Pain
09/10/2022Jennifer SchneiderEmail hidden; Javascript is required.(330) 618-622109/19/202204:00 PM

04/24/76
5th grade teacher
Sam Johnson Elementary : Fall Carnival
Paid $49

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
08/10/2022Robert LopezEmail hidden; Javascript is required.(214) 664-031508/18/202209:00 AM

3/26/1979
Paying in office
Male
Shakertins manager (kitchen I think)

  • Back Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
08/10/2022Mya RobinsonEmail hidden; Javascript is required.(972) 533-228308/17/202205:00 PM

10/10/2000
Paying Monday
Female

  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 51 - 75 of 81