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Screening Survey – The Chiro Place – Bartlett

by | Jun 16, 2022

Displaying 1 - 25 of 76

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
03/25/2023Natalie Dixon[email protected](901) 268-380604/10/202308:30 AM

C.D.
Kipp Health Fair
PAID: SQUARE

  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
03/22/2023Benedict Ibisi[email protected](615) 416-243003/30/202306:00 PM

Paid via square
Youth village screening MC

  • Back Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
02/23/2023Callie Cooper[email protected](731) 612-636310/25/195111:30 AM

Cymphony Davis
Senior Health
Paid: CARD

  • Neck Pain
  • Hip/Leg Pain
03/10/2023Marsha Calhoun[email protected](901) 497-848503/16/202311:00 AM

Paid via Cashapp 3/10
Raleigh Bartlett Meadows Screening

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
03/08/2023Rachel Hayes[email protected](901) 406-742703/13/202303:30 PM

Paid via cashapp
Gordon Academy Screening 3/8 MC

  • Sinus/Allergies
  • Headaches/Migraines
  • Sciatica
01/25/2023Luis Gomez[email protected](901) 937-985301/30/202311:00 AM

Esporta poplar 1.25.23 hs paid via cashapp

  • Back Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
01/25/2023Stephanie Henley[email protected](901) 648-774101/30/202311:00 AM

Granville screening
Paid via cash 1/25/23

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
01/21/2023Julia Martin[email protected](901) 395-747901/26/202306:00 PM

Btown nutrition event 1.21.23 HS paid via cashapp

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
01/21/2023Arely Torres[email protected](901) 417-021401/26/202309:00 AM

Brown nutrition event 1.21.23 HS Paid via cashapp

  • Neck Pain
  • Headaches/Migraines
01/21/2023Laura Harmeier[email protected](901) 238-587401/24/202308:30 AM

Btown nutrition event 1.21.23 HS paid via square

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Headaches/Migraines
  • Shoulder/Arm Pain
01/21/2023Philip Boals[email protected](901) 616-730001/25/202303:30 PM

Brown nutrition event 1.21.23 HS Paid via cashapp

  • Neck Pain
01/18/2023Clara Head[email protected](901) 921-177501/30/202304:00 PM

MBA event 1.18 paid via square HS

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
  • Shoulder/Arm Pain
01/11/2023Keiyoma Dabney[email protected](901) 303-901701/17/202306:00 PM

MC Manassas CASHAPP

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
01/05/2023Hattie Sheppard[email protected](901) 857-288301/10/202311:00 AM

Esporta Bartlett 1.5.23 hs paid via cashapp

  • Back Pain
  • Headaches/Migraines
01/05/2023Damari Burton[email protected](901) 859-326101/09/202310:30 AM

Esporta Bartlett 1.5.23 paid via square HS

  • Shoulder/Arm Pain
12/29/2022Nick Spangenberg[email protected](901) 840-506001/04/202310:30 AM

Hotworx Bartlett event - paid via square HS 12.29

  • Back Pain
  • Neck Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
12/29/2022Nicole Spangenberg[email protected](901) 491-311301/04/202310:30 AM

Hotworx Bartlett event - paid via square HS 12.29

  • Back Pain
  • Neck Pain
12/21/2022Jessica Harris[email protected](901) 649-200201/04/202309:00 AM

Bartlett nutrition event 12/21 - paid via square HS 12.21

  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
12/21/2022Natalia Baldizon[email protected](901) 212-249612/27/202209:00 AM

Bartlett nutrition event 12/21 - paid via cashapp HS 12.21

  • Back Pain
  • Neck Pain
12/19/2022Keith Blanks[email protected](901) 569-710701/05/202310:30 AM

Paid via cash (exact $30) at drennan animal hospital gbmf event - hs 12:19:22

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
12/15/2022Kalyss Looker[email protected](901) 633-337712/22/202206:00 PM

Dove dental event - paid via PayPal 12.15 HS

  • Back Pain
  • Ear Aches
  • Shoulder/Arm Pain
12/12/2022Ode Jones[email protected](601) 862-420212/22/202204:00 PM

Esporta bartlett 12/12 - paid via cashapp -12.12 HS
needs tshirt - out of XL

  • Back Pain
  • Sinus/Allergies
  • Numbness/Tingling
12/07/2022Christal Reed[email protected](731) 415-776712/12/202204:00 PM

Paid for np appt on 12/7 via cashapp - youth villages wellness fair - 12/7 HS

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
12/07/2022Shakina Pool[email protected](901) 562-956512/14/202208:30 AM

Paid for np appt on 12/7 via square - youth villages wellness fair - 12/7 HS

  • Back Pain
12/07/2022Sierra Jackson[email protected](901) 674-432912/15/202206:00 PM

Paid for np appt on 12/7 via cashapp - youth villages wellness fair - 12/7 HS

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 1 - 25 of 76