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Screening Survey – Align Chiropractic Clinic Westside

by | Jun 22, 2022

Displaying 26 - 50 of 92

Screening DateNameEmailPhoneAppointment DateRecently Experienced Symptoms:NOTES: (office use only)Appointment Time
02/24/2023Sherry Golden[email protected](913) 314-234101/01/2016
  • Back Pain
  • Neck Pain
  • Disc Problems
  • Numbness/Tingling
  • Sciatica

In wheelchair
Numbness and tingling in hands and feet

Give them a call

01:00 AM
02/11/2023Kaitlyn Boozer[email protected](636) 293-734204/06/2023
  • Neck Pain
  • Headaches/Migraines

Scoliosis
Maybe only in town for school

12:00 AM
02/10/2023Klarissa DeOrnellis[email protected](573) 645-913002/13/2023
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain

Seed and feed
Es
Card paid

09:00 AM
02/10/2023Julie Campbell[email protected](816) 645-431302/21/2023
  • Back Pain
  • Neck Pain
  • Sinus/Allergies

C4 to c6 took part of the herina
Lower back pain standing long time
Card LW

05:25 AM
02/10/2023Melissa Nichols[email protected](573) 353-815402/21/2023
  • Shoulder/Arm Pain

Left shoulder, mild scoliosis
Cash- LW

03:30 AM
02/10/2023Mary Koestner[email protected](573) 821-370406/12/2010
  • Hip/Leg Pain

Call to check on
Seed and feed

01:00 AM
02/10/2023Jessica Overstreet[email protected](573) 552-209302/14/2023
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica

L5 enlarged

04:35 AM
02/10/2023Andrew Schneider[email protected](636) 357-475603/01/2023
  • Neck Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain

Visa

09:00 AM
02/10/2023Rick Wingate[email protected](573) 418-384103/20/2023
  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Numbness/Tingling
12:00 AM
02/10/2023Derek Henson[email protected](573) 631-341607/11/2015
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain
12:00 AM
02/10/2023Joe Gilbertson[email protected](563) 542-005809/13/2012
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines

Call and check on

01:00 AM
02/10/2023Erin Velarde[email protected](573) 257-133202/13/2023
  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
12:00 PM
02/10/2023Barbara Welschmeyer[email protected](573) 644-269607/09/2011
  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain

Call and check

01:00 AM
02/10/2023Abby Luebbert[email protected](573) 544-886106/06/2011
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
12:00 AM
02/10/2023Rebecca Pierson[email protected](573) 826-166302/27/2023
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain

Meniscus tear in lt shoulder
Mc

Es

04:30 PM
02/10/2023April Vanover[email protected](573) 619-985801/13/2013
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Sciatica
12:00 AM
02/10/2023Haven Nichols[email protected](314) 368-727602/14/2023
  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Disc Problems
  • Shoulder/Arm Pain
12:00 PM
02/10/2023Maria Lowrance[email protected](573) 721-134803/05/2014
  • Back Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain

Call to setup appt- she wants it for her and kiddo
Erika

01:00 AM
02/10/2023Lexi Luebbert[email protected](573) 466-383605/07/2024
  • Back Pain
  • Numbness/Tingling
12:00 AM
02/10/2023Justin Crabtree[email protected](573) 418-825701/01/2010
  • Back Pain

Noo

01:00 AM
02/10/2023Paula Fick[email protected](573) 291-911202/21/2023
  • Sinus/Allergies
02:45 PM
02/10/2023Dustin Flamm[email protected](573) 606-901401/13/2024
  • Back Pain
  • Shoulder/Arm Pain
12:00 AM
02/10/2023Helena Plunkett[email protected](573) 301-307203/15/2023
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines

Birth 1 year ago

05:20 AM
02/10/2023Chealsea Brennan[email protected](401) 692-389302/21/2023
  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica

MC

Es

East

04:30 PM
02/10/2023Allinson Story[email protected](573) 789-029502/23/2023
  • Back Pain
  • Headaches/Migraines
04:30 PM
Screening DateNameEmailPhoneAppointment DateRecently Experienced Symptoms:NOTES: (office use only)Appointment Time

Displaying 26 - 50 of 92