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Screening Survey – Align Chiropractic Clinic Eastside

by | Jun 22, 2022

Displaying 101 - 125 of 188

NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
William Graves04/28/2023Email hidden; Javascript is required.(913) 548-345504/28/202302:00 AM

Hit by a car
Truck blow up in person
He wants schedule after the 15
Call to schedule him

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
Martirrio Porter04/28/2023Email hidden; Javascript is required.(901) 265-393805/04/202309:15 AM

East
Ers

  • Back Pain
Charles Asare04/28/2023Email hidden; Javascript is required.(573) 415-779904/28/202301:00 AM

Rt knee
Call and follow

  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
Gina Gregory04/28/2023Email hidden; Javascript is required.(253) 882-687905/04/202302:45 PM

Colon taken out

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Shaleeta Patterson04/28/2023Email hidden; Javascript is required.(609) 477-488505/10/202312:00 AM

Knee
Lb

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Kari Coers04/28/2023Email hidden; Javascript is required.(573) 202-396301/01/202301:00 AM

Lb disc
Bad hip bone on bone
Call and follow up

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Shoulder/Arm Pain
Victoria Wells04/28/2023Email hidden; Javascript is required.(573) 291-313905/10/202305:20 PM

East
Paying this afternoon card
East

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
Gina Gregory04/28/2023Email hidden; Javascript is required.(253) 882-687905/04/202302:45 PM

Colon taken out

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Pastan Gladden04/28/2023Email hidden; Javascript is required.(573) 797-629805/08/202305:20 PM
  • Back Pain
  • Hip/Leg Pain
Rebecca Gill04/28/2023Email hidden; Javascript is required.(573) 263-291104/06/201601:00 AM
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Disc Problems
  • Sciatica
Jarad Epps04/28/2023Email hidden; Javascript is required.(573) 536-190505/04/202303:30 PM

Lb bulging disc

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
Whitman Kivvle04/28/2023Email hidden; Javascript is required.(573) 230-344105/03/202312:00 PM

Calling to pay over phone
East
Ers

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Helena Sapp04/28/2023Email hidden; Javascript is required.(573) 301-307201/01/202301:00 AM

Baby
Call and follow up

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Dorothy Rieke04/28/2023Email hidden; Javascript is required.(573) 859-384501/01/202301:00 AM

Foot surgery
Carpool tunnel
Call and follow up

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling
  • Shoulder/Arm Pain
Myong Hamilton04/28/2023Email hidden; Javascript is required.(573) 528-574703/04/201101:00 AM

Call for follow up

  • Back Pain
Mike Broker04/27/2023Email hidden; Javascript is required.(573) 469-858005/04/202312:00 AM

Middle back spasm gallbladder removed

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
Adam Dunn04/27/2023Email hidden; Javascript is required.(573) 690-363505/03/202303:30 PM
  • Back Pain
Amber Pitts04/20/2023Email hidden; Javascript is required.(573) 298-386304/24/202309:15 AM
  • Back Pain
  • Headaches/Migraines
Sherry Kempf04/20/2023Email hidden; Javascript is required.(573) 690-877901/01/202302:30 AM

Epilepsy
She is a react

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
Rhonda Rackers04/20/2023Email hidden; Javascript is required.(573) 864-969701/01/202302:30 PM

Open heart surgery pace maker
Call later

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
Erin Sutton04/14/2023Email hidden; Javascript is required.(402) 575-147704/18/202305:20 PM

Carpal tunnel surgery
Numbness down the are to the last three fingers
Superior hip
Heel spurs and planterfacious

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
Nikki Hazelton04/10/2023Email hidden; Javascript is required.(573) 619-371501/01/202301:00 AM
  • Back Pain
Travis Feltrop03/28/2023Email hidden; Javascript is required.(573) 616-910304/05/202309:00 AM
  • Back Pain
  • Hip/Leg Pain
  • Sciatica
  • Shoulder/Arm Pain
Ashley Davis03/28/2023Email hidden; Javascript is required.(573) 418-886101/01/202301:00 AM

Didn’t schedule

  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Lynn Page03/28/2023Email hidden; Javascript is required.(573) 353-204301/01/202301:00 AM

Didn’t schedule

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

Displaying 101 - 125 of 188