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Screening Survey – Align Chiropractic Clinic Eastside

by | Jun 22, 2022

Displaying 76 - 100 of 188

NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
Jean Lambirth05/02/2023Email hidden; Javascript is required.(573) 694-145705/02/202303:00 AM

T11 herniated disc
Call and follow up

  • Disc Problems
Tina Forbis05/02/2023Email hidden; Javascript is required.(573) 694-739305/02/202303:00 AM

Both feet more left
Call at 330

  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
Kara Pabst05/02/2023Email hidden; Javascript is required.(573) 619-257905/02/202303:00 AM

Can call but she was pretty aligned

  • Sinus/Allergies
  • Headaches/Migraines
Linda Rothove05/02/2023Email hidden; Javascript is required.(573) 821-918405/02/202303:00 AM

Left knee

  • Back Pain
  • Hip/Leg Pain
Laura Kempker05/02/2023Email hidden; Javascript is required.(573) 291-980205/02/202303:00 AM

Call and schedule

  • Back Pain
Shellea Hickman05/02/2023Email hidden; Javascript is required.(573) 544-371005/18/202303:30 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
Laura Haslage05/02/2023Email hidden; Javascript is required.(573) 291-044505/17/202309:15 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
Nicole Grothoff05/02/2023Email hidden; Javascript is required.(573) 291-733805/02/202303:00 AM

Has a Chiro

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Renee Stockman05/02/2023Email hidden; Javascript is required.(573) 301-176805/02/202303:00 AM

Call and schedule

  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
Kathy Rackers05/02/2023Email hidden; Javascript is required.(573) 690-121105/02/202303:00 AM

Neuropathy in both feet
Call and follow up

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
Molly Prenger05/02/2023Email hidden; Javascript is required.(573) 694-577105/02/202303:00 AM

Call and schedule

  • Sinus/Allergies
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
Madison Ponder05/01/2023Email hidden; Javascript is required.(573) 291-069405/01/202303:00 AM

Used to be a dancer
Call at 330
She lives in jeff

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Janelle Crow05/01/2023Email hidden; Javascript is required.(573) 690-455505/01/202303:00 AM

Call later she might be hard to convince but she needs it

  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
Oliva Gilpin05/01/2023Email hidden; Javascript is required.(573) 418-486305/01/202303:00 AM

Gallbladder

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Headaches/Migraines
  • Sciatica
Sara Williams05/01/2023Email hidden; Javascript is required.(816) 651-021805/01/202303:00 AM
  • Hip/Leg Pain
  • Sciatica
Taylor Lepage05/01/2023Email hidden; Javascript is required.(573) 353-222605/01/202303:00 AM

Had no pain

  • Back Pain
Amy Rush05/01/2023Email hidden; Javascript is required.(573) 301-584305/01/202303:00 AM

Call and follow up

  • Back Pain
  • Sinus/Allergies
  • Ear Aches
  • Headaches/Migraines
Alisha Adekunle04/28/2023Email hidden; Javascript is required.(573) 915-221803/06/201412:00 AM

Call and get setup

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
Isabella Kelley04/28/2023Email hidden; Javascript is required.(573) 353-037304/08/201812:00 AM

Flat disk in neck
Degenerative disk disease
Muscle work

Call after 3:00

  • Back Pain
Alexia Smith04/28/2023Email hidden; Javascript is required.(573) 337-470704/28/202301:00 AM

Had a child
Call and schedule

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
Edward DeClue04/28/2023Email hidden; Javascript is required.(636) 744-490403/05/202012:00 AM

Call to setup
Ers

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Josh Jones04/28/2023Email hidden; Javascript is required.(573) 469-138505/03/202101:00 AM

Didn’t sign but was interested said his wife goes all the time

  • Sinus/Allergies
David Loggins04/28/2023Email hidden; Javascript is required.(573) 415-795804/28/202302:00 AM

Call and get in

  • Hip/Leg Pain
Luis Perez04/28/2023Email hidden; Javascript is required.(573) 337-519606/12/201412:00 AM

Call to setup
Ers

  • Back Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Vicki Lipe04/28/2023Email hidden; Javascript is required.(573) 462-755004/28/202302:00 AM

Degenerative disc in LB
Call to get schedule

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

Displaying 76 - 100 of 188