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Screening Survey – Align Chiropractic Clinic Eastside

by | Jun 22, 2022

Displaying 126 - 150 of 188

NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
Linda Hutchison05/03/2023Email hidden; Javascript is required.(573) 694-461405/10/202303:30 PM

Fusion at 3,4,5,6

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
Taryn Pritchett05/03/2023Email hidden; Javascript is required.(573) 619-064705/03/202303:00 AM

No

  • Headaches/Migraines
Kim Michaels05/03/2023Email hidden; Javascript is required.(573) 291-189605/03/202303:00 AM
  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
Trevor Grant05/03/2023Email hidden; Javascript is required.(573) 644-022705/03/202303:00 AM

Call him

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
  • Shoulder/Arm Pain
Diana Finnie05/03/2023Email hidden; Javascript is required.(573) 469-124905/03/202303:00 AM

Call

  • Back Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Darnae Johnson05/03/2023Email hidden; Javascript is required.(618) 531-343905/03/202303:00 AM

Call and schedule her at 5:30

  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain
Melissa Small05/03/2023Email hidden; Javascript is required.(573) 619-169805/08/202312:00 AM
  • Back Pain
Rachelle Dunlap05/05/2023Email hidden; Javascript is required.(573) 797-045805/05/202303:00 AM

Call and follow up

  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Holly Bedford05/05/2023Email hidden; Javascript is required.(573) 220-359205/05/202303:00 AM

Low back
Follow up

  • Back Pain
  • Neck Pain
Annette Phillips05/05/2023Email hidden; Javascript is required.(276) 608-431105/05/202303:00 AM

Goes to wheat

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Headaches/Migraines
Lisa Wieberg05/05/2023Email hidden; Javascript is required.(573) 469-880705/05/202303:00 AM

Broken radius in March
Call

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Tracey Bechtel05/05/2023Email hidden; Javascript is required.(573) 578-013105/05/202303:00 AM

Call and schedule

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
Bill Young05/05/2023Email hidden; Javascript is required.(660) 626-402505/05/202303:00 AM

Neuropathy in rt leg
Might call

  • Back Pain
  • Hip/Leg Pain
Anna Bunch05/05/2023Email hidden; Javascript is required.(573) 694-629605/11/202303:00 PM
  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Shoulder/Arm Pain
Leanna Porter05/05/2023Email hidden; Javascript is required.(573) 645-766805/10/202305:20 PM

C1&2 fused from arthritis
Scoliosis in low back

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
Elizabeth Gillen05/05/2023Email hidden; Javascript is required.(573) 418-082405/05/202303:00 AM

Spinal stenosis
Showgirls sendrom
Call Wednesday

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling
  • Shoulder/Arm Pain
Karly Berendzen05/05/2023Email hidden; Javascript is required.(660) 651-160905/05/202303:00 AM

Call and follow up

  • Back Pain
  • Hip/Leg Pain
Shelley Daniels05/05/2023Email hidden; Javascript is required.(573) 645-080905/05/202303:00 AM

Give a call
She will sign in a month

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Jennifer Henderson05/05/2023Email hidden; Javascript is required.(573) 355-082905/05/202303:00 AM

Planterphaitis

  • Hip/Leg Pain
  • Shoulder/Arm Pain
Jan Neighbor05/05/2023Email hidden; Javascript is required.(573) 220-995405/05/202303:00 AM

Total left knee replacement

  • Sinus/Allergies
  • Hip/Leg Pain
Heidi Selenke05/05/2023Email hidden; Javascript is required.(816) 550-250605/05/202303:00 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
Brian Myers05/19/2023Email hidden; Javascript is required.(573) 424-335405/19/202301:00 AM
  • Back Pain
  • Sciatica
Doug Peters05/19/2023Email hidden; Javascript is required.(573) 690-668205/19/202301:00 AM

Screw in the shoulder rt
Call and follow
He goes to the joint but he is looking for more therapy’s like stem and cryo

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
Cole Stirewalt05/19/2023Email hidden; Javascript is required.(618) 977-470805/24/202305:20 PM

Wants to try it out maintenance

  • Back Pain
Kaytlin Schubert05/26/2023Email hidden; Javascript is required.(573) 821-590405/31/202305:20 PM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 126 - 150 of 188