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Screening Survey – Atchley Chiropractic Centers – Castle Hills

by | Jun 9, 2022

Displaying 1 - 25 of 73

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
06/09/2023Mo BannatEmail hidden; Javascript is required.(469) 810-586106/12/202310:30 AM

12/11/23

  • Hip/Leg Pain
05/26/2023Hart HaskinEmail hidden; Javascript is required.(214) 755-069006/06/202308:00 AM

Bike Mart Frisco
1/30/93
Paid $20 Square
No back pain. Injured ribs 2 years ago in a bike accident. Is not experiencing pain currently. But when he does fall to that side off of his bike, it is the same ribs that start to hurt.

  • Back Pain
05/05/2023Nataly ArbildoEmail hidden; Javascript is required.(786) 659-547305/20/202312:00 PM

11/4/1996
Cinco de Mayo Block Party
Paying in office
Headaches/migraines. Takes aspirin on the regular….has been for years
No email provided. Put my own

  • Headaches/Migraines
05/05/2023Matt EdwardsEmail hidden; Javascript is required.(513) 374-099805/10/202309:45 AM

10/7/1977
Cinco de Mayo Block Party
Paid $20 Cash
Military Injuries - helicopter crash 20 years ago

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Disc Problems
  • Shoulder/Arm Pain
04/01/2023Chantel TaylorEmail hidden; Javascript is required.(214) 779-503904/15/202311:00 AM

04/05/1989
Vendor Market in the Plaza
Paid $20 Square

  • Back Pain
03/17/2023Raj BhattacharyaEmail hidden; Javascript is required.(203) 690-874303/21/202303:30 PM

St. Patrick’s Day Event in the Plaza
12/06/81
Paid $20 Square

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
03/17/2023Jamie PamindananEmail hidden; Javascript is required.(214) 938-923503/23/202304:30 PM

St. Patrick’s Event in the Plaza
8/26/82
Paid $20 Square

  • Back Pain
03/02/2023Lucas TchwantoEmail hidden; Javascript is required.(513) 353-827703/06/202303:30 PM

1975
Paid $ 20 Square
MN Frisco Thursday AM

  • Back Pain
  • Hip/Leg Pain
01/29/2023Jeremiah McKnightEmail hidden; Javascript is required.(214) 524-477802/11/202311:30 AM

5/11/07
3/19/79
Appt for son and mom. Wait to book until paid

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
01/29/2023Omar ZenEmail hidden; Javascript is required.(214) 980-599401/31/202305:00 PM

11/16/81
Legends Game

  • Sciatica
  • Shoulder/Arm Pain
01/19/2023Ricardo AlvarezEmail hidden; Javascript is required.(469) 360-944402/02/202305:00 PM

11/10/1989
Acid Reflux sometimes when he lays down
Paid $20 Square

  • Back Pain
  • Neck Pain
01/14/2023Tamera MoralesEmail hidden; Javascript is required.(430) 280-179202/04/202312:00 PM
  • Back Pain
01/15/2023Stephanie RobbinsEmail hidden; Javascript is required.(214) 801-738202/25/202311:30 AM

8/20/78
Paid $20 Square

  • Back Pain
  • Headaches/Migraines
01/13/2023Jhoemon RichardsonEmail hidden; Javascript is required.(972) 322-126301/23/202302:15 PM

10/2/79
Legends Game

  • Back Pain
01/13/2023Olivia ColemanEmail hidden; Javascript is required.(312) 687-004401/14/202311:00 AM

5/10/93

  • Back Pain
01/07/2023Veronica ArandaEmail hidden; Javascript is required.(469) 987-202001/16/202311:00 AM

2/3/72
In office

  • Back Pain
  • Hip/Leg Pain
01/07/2023Alexis LuewellynEmail hidden; Javascript is required.(714) 404-440801/07/202307:00 AM

7/14/73
Paid $20 Square
Legends Game

  • Neck Pain
12/15/2022Braden LoweEmail hidden; Javascript is required.(469) 360-680112/22/202208:30 AM

4/8/2005
Michelle Lowe’s son
Same day appt
First Methodist Preschool

  • Back Pain
12/15/2022Michelle LoweEmail hidden; Javascript is required.(469) 360-680112/22/202208:30 AM

12/4/71
Appt with son
First Methodist Preschool

  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain
12/15/2022Anita SchwarzEmail hidden; Javascript is required.(972) 464-695911/13/202204:00 AM

12/28/92
Reach out after Christmas

  • Back Pain
  • Headaches/Migraines
12/15/2022Nazik IbraeveEmail hidden; Javascript is required.(214) 605-898801/09/202204:00 AM

March 5, 1979
Needs to talk to husband. Reach out after Christmas

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
12/15/2022Whitney YamadaEmail hidden; Javascript is required.(409) 779-282812/21/202210:00 AM

4/28/87
Diagnosed Neuropathy
Paid $49 w

  • Back Pain
  • Neck Pain
12/15/2022Larry ReedEmail hidden; Javascript is required.(972) 742-771812/21/202203:30 PM

6/13/61
Paid $20 Cash
First Methodist Church

  • Back Pain
12/15/2022Brianna WalpoolEmail hidden; Javascript is required.(469) 823-814201/03/202304:00 PM

02/22/2000
$20 Cash
First Methodist Church

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
12/15/2022Jackelyn ArguetaEmail hidden; Javascript is required.(214) 476-940310/01/202206:00 AM

10/18/93
Reach out after holidays

  • Back Pain
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 1 - 25 of 73