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Screening Survey – The Chiro Place – Southaven

by | Jun 16, 2022

Displaying 1 - 25 of 82

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
04/18/2023Evelyn Merriweather[email protected](901) 237-049404/27/202311:00 AM

BellSouth Ret.
AS

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
  • Shoulder/Arm Pain
04/18/2023Linda Miller[email protected](901) 949-717804/25/202303:30 PM

BellSouth Retirement
A.S.
PAID: SQUARE (paid at 12:46)

  • Back Pain
  • Hip/Leg Pain
  • Disc Problems
04/18/2023Beverly Boyd[email protected](901) 608-209904/24/202309:00 AM

AS
Paid Cash

  • Neck Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
04/18/2023Evelyn Merriweather[email protected](901) 237-049404/25/202304:30 PM

BellSouth Retirement
PAID :SQUARE (paid @ 11:15)
C.D.

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
  • Shoulder/Arm Pain
04/18/2023Sandra Russell[email protected](901) 568-472304/20/202310:30 AM

Bell South Retirement Group
C.D.
PAID:SQUARE

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Sciatica
03/25/2023Olivia Holmes[email protected](901) 691-066404/03/202303:30 PM

A.S.
KIPP HEALTH FAIR
PAID SQUARE

  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
03/25/2023Priscilla Blackmon[email protected](901) 409-402803/30/202303:30 PM

A. S.
Kipp Health Fair
PAID SQUARE

  • Back Pain
  • Neck Pain
  • Sciatica
03/25/2023Kimberley Wooten[email protected](901) 229-100003/29/197406:00 PM
  • Back Pain
  • Sinus/Allergies
  • Numbness/Tingling
03/22/2023Miranda Clark[email protected](662) 548-664204/03/202304:00 PM

Paid via Cashapp
Youth village screening MC

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
03/15/2023Roseetta Robinson[email protected](901) 486-820603/21/202308:30 AM

C.D.
HUTCHINSON
Paid: SQUARE

  • Back Pain
02/23/2023Junita Spry[email protected](901) 859-611903/07/202306:30 PM

Dedicated Senior Medical
Cymphony
PAID: Cashapp

  • Back Pain
  • Neck Pain
  • Disc Problems
  • Shoulder/Arm Pain
01/30/2023Carolyn Richmond[email protected](901) 428-677202/02/202309:00 AM

Paid cash
Dedicated senior center MC 1/30

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
01/30/2023Jacqueline Jacksonn/[email protected](901) 789-941502/02/202308:30 AM

Paid via square
Dedicated senior center MC 1/30

  • Back Pain
01/30/2023Dorothy Waden/[email protected](901) 603-654802/02/202308:30 AM

Paid via square
Dedicated senior center screening Mc 1/30

  • Back Pain
01/18/2023Cymphony Davis[email protected](870) 316-393801/31/202305:30 PM

Germantown Elem.
1/18/23
PAID: Cashapp
C.D.

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
01/17/2023Cheryl Williams[email protected](901) 301-034201/18/202308:30 AM

Paid via cash app
Robert R church elementary school screening

  • Back Pain
  • Neck Pain
  • Shoulder/Arm Pain
12/02/2022Paula Gagnier[email protected](626) 644-037001/18/202311:00 AM

01/14/2023
Vision Party
Cymphony
PAID: Cashapp

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Numbness/Tingling
12/07/2022Zoe Brasher[email protected](901) 734-114212/12/202209:00 AM

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

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Sciatica
12/02/2022Malorie Osteen[email protected](662) 551-606312/08/202210:30 AM

YMCA Olive Branch
Paid via cashapp 12/2 MC

  • Back Pain
11/17/2022Josef Woody[email protected](901) 240-344211/23/202209:00 AM

Paid Cash at Southwind Resource Night

  • Back Pain
  • Neck Pain
11/16/2022Star Brown[email protected](901) 453-516911/29/202206:00 PM

Paid via cashapp
Dfusion
PO

  • Back Pain
  • Neck Pain
11/16/2022Naya Washington[email protected](501) 508-381312/08/202208:30 AM

ADFusion
Paid cash app
PO 11/15

  • Neck Pain
11/16/2022Lakedra Hampton[email protected](662) 613-020112/01/202204:00 PM

Needs to pay

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
11/10/2022Deandre Carroll[email protected](901) 450-173711/15/202206:00 PM

Smith & Nephew McKenzie

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
11/10/2022Charles McClure[email protected](901) 650-731311/14/202203:30 PM

Smith & Nephew M.

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Numbness/Tingling
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 1 - 25 of 82