Select Page

Screening Survey – Align Chiropractic Clinic Eastside

by | Jun 22, 2022

Displaying 26 - 50 of 188

NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
Tammy Surface06/15/2023Email hidden; Javascript is required.(573) 263-610506/15/202301:00 AM

Arthritis lower to mid
Torn rotator cuff
Call and set up

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Rae Mcmullen06/03/2023Email hidden; Javascript is required.(312) 792-992606/03/202301:00 AM

Call

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Celesta Buchanan06/03/2023Email hidden; Javascript is required.(573) 533-188806/05/202303:30 PM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Nolan Hall06/03/2023Email hidden; Javascript is required.(636) 659-216906/03/202301:00 AM

Maint kid
Josh hall 5732302779

  • Back Pain
  • Hip/Leg Pain
Kailie Wheeler06/03/2023Email hidden; Javascript is required.(573) 353-920706/08/202309:15 AM
  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Sciatica
Amora Greenlee06/03/2023Email hidden; Javascript is required.(573) 462-602806/03/202301:00 AM

Plays basket ball, soccer, follow up

  • Sinus/Allergies
Mulima Walusiku06/03/2023Email hidden; Javascript is required.(573) 353-793506/07/202312:00 AM

We’re apt

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
Michelle Bordelon06/03/2023Email hidden; Javascript is required.(573) 355-171106/03/202301:00 AM

Stenosis

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Shoulder/Arm Pain
Ashley Gilley06/03/2023Email hidden; Javascript is required.(573) 555-555506/03/202301:00 AM

Car accident 2009

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Liz Haskamp06/03/2023Email hidden; Javascript is required.(573) 353-531206/03/202301:00 AM

Cyst on both hands

  • Back Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
Caitlin Eggen06/03/2023Email hidden; Javascript is required.(573) 418-424806/03/202301:00 AM

Just had a baby

  • Neck Pain
Sabrina Cobbs06/03/2023Email hidden; Javascript is required.(573) 230-429606/03/202301:00 AM

Call and follow up

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Megan Goetz06/03/2023Email hidden; Javascript is required.(573) 353-573706/03/202301:00 AM

Throw back lower back out

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Sciatica
  • Shoulder/Arm Pain
Kaytlin Schubert05/26/2023Email hidden; Javascript is required.(573) 821-590405/31/202305:20 PM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Cole Stirewalt05/19/2023Email hidden; Javascript is required.(618) 977-470805/24/202305:20 PM

Wants to try it out maintenance

  • Back Pain
Doug Peters05/19/2023Email hidden; Javascript is required.(573) 690-668205/19/202301:00 AM

Screw in the shoulder rt
Call and follow
He goes to the joint but he is looking for more therapy’s like stem and cryo

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
Brian Myers05/19/2023Email hidden; Javascript is required.(573) 424-335405/19/202301:00 AM
  • Back Pain
  • Sciatica
Heidi Selenke05/05/2023Email hidden; Javascript is required.(816) 550-250605/05/202303:00 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
Jan Neighbor05/05/2023Email hidden; Javascript is required.(573) 220-995405/05/202303:00 AM

Total left knee replacement

  • Sinus/Allergies
  • Hip/Leg Pain
Jennifer Henderson05/05/2023Email hidden; Javascript is required.(573) 355-082905/05/202303:00 AM

Planterphaitis

  • Hip/Leg Pain
  • Shoulder/Arm Pain
Shelley Daniels05/05/2023Email hidden; Javascript is required.(573) 645-080905/05/202303:00 AM

Give a call
She will sign in a month

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Karly Berendzen05/05/2023Email hidden; Javascript is required.(660) 651-160905/05/202303:00 AM

Call and follow up

  • Back Pain
  • Hip/Leg Pain
Elizabeth Gillen05/05/2023Email hidden; Javascript is required.(573) 418-082405/05/202303:00 AM

Spinal stenosis
Showgirls sendrom
Call Wednesday

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling
  • Shoulder/Arm Pain
Leanna Porter05/05/2023Email hidden; Javascript is required.(573) 645-766805/10/202305:20 PM

C1&2 fused from arthritis
Scoliosis in low back

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
Anna Bunch05/05/2023Email hidden; Javascript is required.(573) 694-629605/11/202303:00 PM
  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Shoulder/Arm Pain
NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 26 - 50 of 188