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Screening Survey – Atchley Chiropractic Centers – Castle Hills

by | Jun 9, 2022

Displaying 26 - 50 of 73

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
12/15/2022Bridget OrellanaEmail hidden; Javascript is required.(817) 805-153812/21/202208:00 AM

3/30/95
Paid $49 Square
First Methodist Church

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
12/10/2022Mia RamirezEmail hidden; Javascript is required.(214) 608-942612/14/202205:00 PM

5/28/2010
Bianca Avendano - Mother
Paid $20 Square
Legends Game

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
12/10/2022Raphael GarzaEmail hidden; Javascript is required.(214) 677-696912/30/202207:15 AM

5/1/93
Paid $20 Square
Lower occasional back pain
Dragonfly CoffeeHouse

  • Back Pain
12/10/2022Christabelle BardelozaEmail hidden; Javascript is required.(214) 601-705712/19/202202:00 PM

1/5/90
Paid $20 Square
Sister of Kristeen Muth!
Dragonfly CoffeeHouse
Appt in schedule

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Sciatica
12/10/2022Candy RazoEmail hidden; Javascript is required.(214) 853-366812/13/202203:30 PM

12/24/93
Paid $20 Cash
Dragonfly CoffeeHouse vendor market
Appt is in schedule

  • Back Pain
11/26/2022Candice WardlawEmail hidden; Javascript is required.(972) 374-880512/06/202204:45 PM

6/29/1990
Lower back pain
Paid $20 Square
Legends Game

  • Back Pain
11/21/2022Katelyn RobinsonEmail hidden; Javascript is required.(817) 226-857511/22/202203:45 PM

3/2/2001
Paying in office
Please call to confirm in the morning!!!
Legends Game

  • Back Pain
  • Neck Pain
11/21/2022Felipe AlambarEmail hidden; Javascript is required.(956) 274-246501/07/202211:00 AM

1/22/88
Pinched nerve in back
Teacher in Dallas
Paid $20 Cash
Legends Game

  • Back Pain
  • Hip/Leg Pain
11/18/2022Jessica JonesEmail hidden; Javascript is required.(817) 823-462112/09/202211:00 AM

4/11/90
Legends Game

  • Back Pain
  • Neck Pain
11/10/2022Lisa BrumitEmail hidden; Javascript is required.(361) 774-772501/02/202306:00 AM

Forney 75126
Find closer integrity doc

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
11/09/2022LaQuinta NealEmail hidden; Javascript is required.(501) 993-076511/21/202202:30 PM

10/20/79
Knee issues

  • Back Pain
  • Neck Pain
11/09/2022Felisha WilliamsEmail hidden; Javascript is required.(318) 348-981111/16/202208:00 AM

8/10/72

  • Neck Pain
  • Hip/Leg Pain
10/29/2022Gavin KrimmEmail hidden; Javascript is required.(972) 786-371211/03/202207:30 AM

5/2/90
Paid $20
CH Fall Festival 9/29

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Shoulder/Arm Pain
10/29/2022Cinthia PalaciosEmail hidden; Javascript is required.(214) 600-069011/02/202205:00 PM

07/4/90
Paying in office

  • Back Pain
  • Neck Pain
10/21/2022Burke BeckerEmail hidden; Javascript is required.(214) 491-916211/05/202212:00 PM

07/16/1991
Paid $49 Square

  • Back Pain
10/18/2022Esmeralda ArambulaEmail hidden; Javascript is required.(310) 709-569610/29/202212:00 PM

L4 L5 herniated disk
Surgery 2014
Paid $20 cash

  • Back Pain
  • Sinus/Allergies
  • Ear Aches
  • Sciatica
09/24/2022Aileen PesanteEmail hidden; Javascript is required.(469) 412-922210/04/202209:00 AM

09/5/87
Paid $49

  • Back Pain
09/25/2022Kelly RoarkEmail hidden; Javascript is required.(972) 977-775210/06/202202:00 PM

5/10/71
Paid $49

  • Back Pain
09/25/2022Morgan CrawfordEmail hidden; Javascript is required.(940) 597-312710/05/202203:45 PM

Aug 23 1999
Pay at appt

  • Disc Problems
09/25/2022Shane ElrodEmail hidden; Javascript is required.(469) 876-045610/22/202212:00 PM

3/25/71
Paid $20 cash

  • Neck Pain
  • Headaches/Migraines
  • Sciatica
09/24/2022Manna JohnsonEmail hidden; Javascript is required.(903) 790-746610/22/202210:00 AM

11/08/82
Paid $20 cash

  • Back Pain
09/24/2022Aaron RobertsEmail hidden; Javascript is required.(469) 671-706110/08/202211:00 AM

07/17/1978
Last chiro told him no
Paid $20

  • Back Pain
  • Disc Problems
09/24/2022Lizeth GodinezEmail hidden; Javascript is required.(214) 995-622210/08/202212:00 PM

1/4/04

  • Back Pain
  • Neck Pain
09/24/2022Mary HendersonEmail hidden; Javascript is required.(971) 724-896910/05/202208:15 AM

7/18/1982
Can’t hear out of left ear
Doctor Atchley
Paid $49

  • Ear Aches
09/23/2022Daniella PerezEmail hidden; Javascript is required.(469) 396-660409/23/202205:00 AM

Aug 31, 1990

Email with times

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

Displaying 26 - 50 of 73