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Screening Survey – Riggs Chiropractic – Riverton

by | May 20, 2022

Displaying 26 - 50 of 56

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
10/13/2022Angie Kelly[email protected](539) 577-902610/19/202210:00 AM

Becca- Quapaw Fitness center, Severe spinal stenosis c5 & 6, arms and legs numbness,

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
10/07/2022Shirley Eiland[email protected](620) 249-607510/13/202210:00 AM

Becca- Quapaw fm, Back pain-has had back surgery & is experiencing right hip pain,

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Sciatica
09/20/2022Danielle Drake[email protected](417) 438-307909/23/202211:15 AM

Becca - 24 Hr Elite Hip pain - left, neck left, 2/wk headaches, numbness in hands and feet,

  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
09/16/2022Michael Roberson[email protected](918) 961-292909/19/202211:15 AM

Becca- Quapaw fm - Lbp, neck pain, right hip, lower lumbar disc problems, right leg, both shoulders

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
09/16/2022Misty Scott[email protected](918) 533-375309/19/202209:45 AM

Lbp (herniated disc), 1/month headaches, both shoulders- versititis,

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
09/13/2022Kylie Rogers[email protected](620) 304-175909/14/202209:00 AM

Mbp, ear aches 1/2 month, everyday, left foot numbness, shoulder pain both

  • Back Pain
  • Ear Aches
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
09/13/2022Mark Gentry[email protected](417) 291-626309/22/202209:45 AM

Becca-Weston’s: mid back to shoulders, neck pain, neuropathy, left hip and leg, mentioned a compression fracture he had yrs back but not sure where, sciatica radiates to left side

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
09/13/2022Kim Gentry[email protected](417) 291-626309/22/202209:45 AM

Becca-Weston’s: Shoulders, jaw pain, right shoulder, has been sick and throwing up a lot so lots of upper back pain right now,

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Shoulder/Arm Pain
09/07/2022Cristy Hussong[email protected](620) 210-181609/15/202210:30 AM

Becca-JBirds, PD -CK#2227, HH-sent, Lbp radiates into stomach and into legs, 2/wk, num right arm,

  • Back Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
09/06/2022Jeff Wary[email protected](620) 762-310209/14/202209:00 AM

Becca- Davis Real Estate cust. Appreciation, PD-clover, Pain from to shoulders to hips & knee, neck, right elbow pain

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
08/31/2022Raven Wendling[email protected](620) 249-328909/15/202202:30 PM

Whole back, left hip, 2/wk headaches,

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
08/25/2022Deven Newman[email protected](620) 210-186609/08/202207:45 AM

Becca-JBirds, lbp, is missing a vertebrae - wife wasn’t sure which one,

  • Back Pain
08/25/2022Alex Newman[email protected](620) 210-414608/31/202202:45 PM

Becca-JBirds, lbp, numbness tingling in left elbow, headaches,

  • Back Pain
  • Headaches/Migraines
  • Numbness/Tingling
08/19/2022Jason Reeves[email protected](918) 533-556208/24/202208:15 AM

Becca - Quapaw fm, hurts from shoulder blades down, neck pain everyday, left leg & hip, broke tibia twice, arms tingle sometimes- more the right one, shoulder right - torn ligaments 6/7 yrs ago,

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
08/19/2022Roy Hodges[email protected](417) 438-842408/30/202209:00 AM

Becca-Quapaw fm - pd clover for him and wife, Mid & lbp back, ran over by a tractor like 20 yrs ago, both shoulders operated on, recent(April) survey for cancer lump on his neck, numbness & tingling in extremities, sciatica, left shoulder since surgery,

  • Back Pain
  • Neck Pain
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
08/19/2022Lettie Hodges[email protected](417) 438-842408/29/202202:45 PM

Right hip, neck-doesn’t have full range emotion, sinus headaches, osteoporosis, has had a spur and bulging disc at some point over the yrs, sciatica, has had surgery on right shoulder

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Sciatica
  • Shoulder/Arm Pain
08/12/2022Cameron Miller[email protected](620) 249-527508/22/202210:45 AM

Lbp, neck pain right side, right knee, right shoulder,

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
08/12/2022Dalton Beckett[email protected](417) 317-909008/24/202209:00 AM

Lbp, neck pain, hip pain right, right shoulder, has been in several car accidents he said

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
08/12/2022Daniel Sharp[email protected](417) 825-422708/18/202207:00 AM

Mid back pain, hip & leg pain right, numbness & tingling in neck on occasion, right shoulder (some from wreck 17 yrs ago) saw a chiro briefly then

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
08/12/2022Devon Ruddick[email protected](417) 629-205508/23/202209:15 AM

Lbp, right hip, headaches 4-7 per week,

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
08/11/2022Robert Mills[email protected](918) 541-334208/16/202209:00 AM

Becca- Weston’s, pd- cash, Lbp, sciatica left leg, numbness on that left side, right shoulder, right head pain behind ear,

  • Back Pain
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
08/11/2022James Barrett[email protected](417) 439-029508/17/202209:15 AM

Becca-Weston’s, pd-cash, 2/wk headaches, upper left back pain,

  • Back Pain
  • Headaches/Migraines
08/11/2022Donna Barrett[email protected](417) 439-083408/18/202203:00 PM

Becca- Weston’s, Already paid like a long time ago, Right hip, knees, right shoulder

  • Hip/Leg Pain
  • Shoulder/Arm Pain
08/09/2022Paul Mashburn[email protected](918) 919-900108/11/202209:15 AM

Becca- Quapaw Fitness, reports no pain except for arthritis

  • Back Pain
08/02/2022Jairo Lara[email protected](417) 396-557608/11/202209:00 AM
  • Hip/Leg Pain
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 26 - 50 of 56