Select Page

Screening Survey – Align Chiropractic Clinic Eastside

by | Jun 22, 2022

Displaying 151 - 175 of 188

NameScreening DateEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
Megan Goetz06/03/2023Email hidden; Javascript is required.(573) 353-573706/03/202301:00 AM

Throw back lower back out

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Sciatica
  • Shoulder/Arm Pain
Sabrina Cobbs06/03/2023Email hidden; Javascript is required.(573) 230-429606/03/202301:00 AM

Call and follow up

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Caitlin Eggen06/03/2023Email hidden; Javascript is required.(573) 418-424806/03/202301:00 AM

Just had a baby

  • Neck Pain
Liz Haskamp06/03/2023Email hidden; Javascript is required.(573) 353-531206/03/202301:00 AM

Cyst on both hands

  • Back Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
Ashley Gilley06/03/2023Email hidden; Javascript is required.(573) 555-555506/03/202301:00 AM

Car accident 2009

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Michelle Bordelon06/03/2023Email hidden; Javascript is required.(573) 355-171106/03/202301:00 AM

Stenosis

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Shoulder/Arm Pain
Mulima Walusiku06/03/2023Email hidden; Javascript is required.(573) 353-793506/07/202312:00 AM

We’re apt

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
Amora Greenlee06/03/2023Email hidden; Javascript is required.(573) 462-602806/03/202301:00 AM

Plays basket ball, soccer, follow up

  • Sinus/Allergies
Kailie Wheeler06/03/2023Email hidden; Javascript is required.(573) 353-920706/08/202309:15 AM
  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Disc Problems
  • Sciatica
Nolan Hall06/03/2023Email hidden; Javascript is required.(636) 659-216906/03/202301:00 AM

Maint kid
Josh hall 5732302779

  • Back Pain
  • Hip/Leg Pain
Celesta Buchanan06/03/2023Email hidden; Javascript is required.(573) 533-188806/05/202303:30 PM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Rae Mcmullen06/03/2023Email hidden; Javascript is required.(312) 792-992606/03/202301:00 AM

Call

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Tammy Surface06/15/2023Email hidden; Javascript is required.(573) 263-610506/15/202301:00 AM

Arthritis lower to mid
Torn rotator cuff
Call and set up

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Trinity Williamson06/15/2023Email hidden; Javascript is required.(417) 770-542006/15/202301:00 AM
  • Back Pain
  • Hip/Leg Pain
Haley Logan06/15/2023Email hidden; Javascript is required.(573) 263-692206/19/202309:00 AM

Rat kidney removed

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
Christine Grover06/15/2023Email hidden; Javascript is required.(573) 291-257606/15/202301:00 AM

Goes to kiazer

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
  • Shoulder/Arm Pain
Alyssa Rollins06/15/2023Email hidden; Javascript is required.(573) 690-396506/15/202301:00 AM

Is pregnant

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
Jordanna Mcleod06/21/2023Email hidden; Javascript is required.(417) 214-632606/21/202301:00 AM

Calf’s tighten
Might have
Call and schedule

  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Kenny Voss06/21/2023Email hidden; Javascript is required.(573) 298-208906/21/202301:00 AM

Muscle pain
Bad foot injury left foot
Broken pelvis left
Email to follow up

  • Sinus/Allergies
  • Hip/Leg Pain
Mandy Stuckey06/22/2023Email hidden; Javascript is required.(573) 590-268006/21/202301:00 AM

Car accident about 3 years ago
C5 is disc is herniated
Call and get in

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Michael Dillingham06/22/2023Email hidden; Javascript is required.(314) 779-757606/27/202305:20 PM

3 shoulder surgeries rat shoulder

  • Back Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
Adrian Nuse06/23/2023Email hidden; Javascript is required.(573) 632-302106/23/202301:00 AM

He is homeless and can’t make it to jeff

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
Angela Worsham06/23/2023Email hidden; Javascript is required.(573) 219-774806/23/202301:00 AM

Both hands tingling

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
Mike Johnson06/23/2023Email hidden; Javascript is required.(573) 220-145806/23/202301:00 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
Connie Foust06/24/2023Email hidden; Javascript is required.(573) 220-498406/24/202301:00 AM

We are too far

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

Displaying 151 - 175 of 188