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Screening Survey – Align Chiropractic Clinic Eastside

by | Jun 22, 2022

Displaying 51 - 75 of 188

NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
Bill Young05/05/2023Email hidden; Javascript is required.(660) 626-402505/05/202303:00 AM

Neuropathy in rt leg
Might call

  • Back Pain
  • Hip/Leg Pain
Tracey Bechtel05/05/2023Email hidden; Javascript is required.(573) 578-013105/05/202303:00 AM

Call and schedule

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
Lisa Wieberg05/05/2023Email hidden; Javascript is required.(573) 469-880705/05/202303:00 AM

Broken radius in March
Call

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Annette Phillips05/05/2023Email hidden; Javascript is required.(276) 608-431105/05/202303:00 AM

Goes to wheat

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Headaches/Migraines
Holly Bedford05/05/2023Email hidden; Javascript is required.(573) 220-359205/05/202303:00 AM

Low back
Follow up

  • Back Pain
  • Neck Pain
Rachelle Dunlap05/05/2023Email hidden; Javascript is required.(573) 797-045805/05/202303:00 AM

Call and follow up

  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Melissa Small05/03/2023Email hidden; Javascript is required.(573) 619-169805/08/202312:00 AM
  • Back Pain
Darnae Johnson05/03/2023Email hidden; Javascript is required.(618) 531-343905/03/202303:00 AM

Call and schedule her at 5:30

  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain
Diana Finnie05/03/2023Email hidden; Javascript is required.(573) 469-124905/03/202303:00 AM

Call

  • Back Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Trevor Grant05/03/2023Email hidden; Javascript is required.(573) 644-022705/03/202303:00 AM

Call him

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
  • Shoulder/Arm Pain
Kim Michaels05/03/2023Email hidden; Javascript is required.(573) 291-189605/03/202303:00 AM
  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
Taryn Pritchett05/03/2023Email hidden; Javascript is required.(573) 619-064705/03/202303:00 AM

No

  • Headaches/Migraines
Linda Hutchison05/03/2023Email hidden; Javascript is required.(573) 694-461405/10/202303:30 PM

Fusion at 3,4,5,6

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
Kelly Moeller05/03/2023Email hidden; Javascript is required.(573) 619-017305/03/202303:00 AM

Call and follow up

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
Kiley Neubert05/03/2023Email hidden; Javascript is required.(573) 842-049605/11/202305:20 PM

2 cal surgery both knees

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Kayla Lute05/03/2023Email hidden; Javascript is required.(573) 694-454605/03/202303:00 AM

Call at 330 and schedule her she is super willing she just didn’t have the time

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
Mason Johnson05/03/2023Email hidden; Javascript is required.(573) 584-120105/03/202303:00 AM

Call and follow up

  • Back Pain
  • Sinus/Allergies
Andrew Brunnert05/02/2023Email hidden; Javascript is required.(770) 510-313805/02/202303:00 AM
  • Back Pain
  • Headaches/Migraines
Elaine Callaway05/02/2023Email hidden; Javascript is required.(573) 690-896605/11/202302:45 AM

Double mastectomy

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
Laurence Hogg05/02/2023Email hidden; Javascript is required.(573) 529-433705/02/202303:00 AM

Low back

  • Back Pain
  • Neck Pain
Lisa Esterline05/02/2023Email hidden; Javascript is required.(573) 691-372005/11/202302:45 AM

Bursitis in rt hip low back pain is new
Pt for a long time with no results
Hip flexor

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Mary Hiatte05/02/2023Email hidden; Javascript is required.(573) 896-537705/02/202303:00 AM

From surgery
Dengerative disc disease

  • Back Pain
  • Neck Pain
  • Disc Problems
  • Numbness/Tingling
Peggy Markway05/02/2023Email hidden; Javascript is required.(573) 690-458005/15/202312:00 AM
  • Sinus/Allergies
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Cindy McEUen05/02/2023Email hidden; Javascript is required.(573) 783-162305/02/202303:09 AM

L3 and L 5 disc
Neuropathy in feet both more in rt
Rt shoulder pt just done

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Shoulder/Arm Pain
Michelle Malone05/02/2023Email hidden; Javascript is required.(573) 616-985805/02/202303:00 AM

Steroid shot in the shoulder
3wheeler crash
Call and follow up

  • Sinus/Allergies
  • Hip/Leg Pain
NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 51 - 75 of 188