Screening Survey – Align Chiropractic Clinic Westside

by joeln_ID | Jun 22, 2022

Displaying 76 - 92 of 92

Screening Date	Name	Email	Phone	Appointment Date	Recently Experienced Symptoms:	NOTES: (office use only)	Appointment Time
01/08/2023	Rosa Stone	[email protected]	(573) 338-4969	01/23/2023	Back Pain Neck Pain Sinus/Allergies Ear Aches Hip/Leg Pain Headaches/Migraines Numbness/Tingling Sciatica Shoulder/Arm Pain	Jeremiah Luper Antonio LuperStone Johns West Paid -mc	05:20 AM
01/08/2023	Erin Boeckmann	[email protected]	(573) 645-3396	01/01/2020	Back Pain Neck Pain		01:00 AM
01/08/2023	Halie Eaton	[email protected]	(573) 508-8374	01/16/2023	Back Pain Hip/Leg Pain Headaches/Migraines Shoulder/Arm Pain	Erika Cash-20.00 west	05:20 AM
01/08/2023	Nancy Jeffries	[email protected]	(573) 864-7629	02/02/2011	Sinus/Allergies Hip/Leg Pain		01:00 AM
01/08/2023	Vanessa Jeffries	[email protected]	(573) 864-3934	01/08/2023	Back Pain Neck Pain Ear Aches Headaches/Migraines		01:15 PM
01/08/2023	Lauren Alexander	[email protected]	(573) 418-5760	01/11/2023	Neck Pain Shoulder/Arm Pain	DrJ Had an inflamed rotator cuff treating it with anti inflammatory Ed Didn’t have wallet call monday	09:15 AM
01/08/2023	Kelsey Schenewerk	[email protected]	(573) 301-9012	01/01/2012	Back Pain Neck Pain Headaches/Migraines		01:00 AM
01/08/2023	Tristen Briscoe	[email protected]	(573) 540-8637	01/18/2023	Back Pain Neck Pain Sinus/Allergies Hip/Leg Pain Headaches/Migraines Shoulder/Arm Pain	DrJ Lots	05:20 PM
01/08/2023	Rachel Wilson	[email protected]	(573) 619-9461	01/18/2022	Back Pain Neck Pain Sinus/Allergies Hip/Leg Pain Headaches/Migraines	Erika 20.00-mc West	05:20 PM
01/08/2023	Maddie Allman	[email protected]	(573) 616-6361	01/13/2023	Back Pain	DrJ No go has Chiro in California	01:00 AM
01/08/2023	Sydney Nevins	[email protected]	(573) 691-2289	01/01/2012	Back Pain Neck Pain Ear Aches Headaches/Migraines Numbness/Tingling Shoulder/Arm Pain		01:00 AM
01/08/2023	Cassie Twehus	[email protected]	(573) 691-7414	01/17/2023	Back Pain Headaches/Migraines Numbness/Tingling	DrJ Super excited to get in Numbness in hands with sleeping	04:35 PM
01/08/2023	Deanne Twehus	[email protected]	(573) 680-0086	01/10/2023	Back Pain Neck Pain Hip/Leg Pain Disc Problems Numbness/Tingling	Erika Paid mc_20.00 West	05:20 AM
01/08/2023	Anna Massman	[email protected]	(573) 690-3798	06/03/2023	Neck Pain Headaches/Migraines	DrJ Was a no	01:00 AM
01/08/2023	Nancy Massman	[email protected]	(573) 418-8295	04/03/2020	Neck Pain		01:00 AM
01/08/2023	Teresa Cook	[email protected]	(573) 291-6908	05/02/2015	Back Pain		01:00 AM
01/08/2023	Katelyn Huhn	[email protected]	(573) 680-2650	03/05/2020	Neck Pain Headaches/Migraines	DrJ lived in southeast MO was a no go	01:20 AM
Screening Date	Name	Email	Phone	Appointment Date	Recently Experienced Symptoms:	NOTES: (office use only)	Appointment Time