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Screening Survey – Align Chiropractic Clinic Westside

by | Jun 22, 2022

Displaying 1 - 25 of 92

Screening DateNameEmailPhoneAppointment DateRecently Experienced Symptoms:NOTES: (office use only)Appointment Time
01/08/2023Katelyn Huhnkatelyn.m.huhn@gmail.com(573) 680-265003/05/2020
  • Neck Pain
  • Headaches/Migraines

DrJ lived in southeast MO was a no go

01:20 AM
01/08/2023Teresa Cooktlctree13@yahoo.com(573) 291-690805/02/2015
  • Back Pain
01:00 AM
01/08/2023Nancy Massmanmassmanfolk@gmail.com(573) 418-829504/03/2020
  • Neck Pain
01:00 AM
01/08/2023Anna Massmananna.annarose1998@gmail.com(573) 690-379806/03/2023
  • Neck Pain
  • Headaches/Migraines

DrJ
Was a no

01:00 AM
01/08/2023Deanne Twehusdeannetwehus@gmail.com(573) 680-008601/10/2023
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling

Erika
Paid mc_20.00
West

05:20 AM
01/08/2023Cassie Twehuscassjo19@yahoo.com(573) 691-741401/17/2023
  • Back Pain
  • Headaches/Migraines
  • Numbness/Tingling

DrJ
Super excited to get in
Numbness in hands with sleeping

04:35 PM
01/08/2023Sydney Nevinsnevinsydney2013@yahoo.com(573) 691-228901/01/2012
  • Back Pain
  • Neck Pain
  • Ear Aches
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
01:00 AM
01/08/2023Maddie Allmanmadelineallman98@gmail.com(573) 616-636101/13/2023
  • Back Pain

DrJ
No go has Chiro in California

01:00 AM
01/08/2023Rachel Wilsonrmwjoc2020@icloud.com(573) 619-946101/18/2022
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines

Erika
20.00-mc
West

05:20 PM
01/08/2023Tristen Briscoetristen.j.briscow@gmail.con(573) 540-863701/18/2023
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain

DrJ
Lots

05:20 PM
01/08/2023Kelsey Schenewerkkels.scheny@gmail.com(573) 301-901201/01/2012
  • Back Pain
  • Neck Pain
  • Headaches/Migraines
01:00 AM
01/08/2023Lauren Alexanderlaurenealexander4@gmail.com(573) 418-576001/11/2023
  • Neck Pain
  • Shoulder/Arm Pain

DrJ
Had an inflamed rotator cuff treating it with anti inflammatory Ed
Didn’t have wallet call monday

09:15 AM
01/08/2023Vanessa Jeffriesvanessagjeffries98@gmail.com(573) 864-393401/08/2023
  • Back Pain
  • Neck Pain
  • Ear Aches
  • Headaches/Migraines
01:15 PM
01/08/2023Nancy Jeffrieskncvj@yahoo.com(573) 864-762902/02/2011
  • Sinus/Allergies
  • Hip/Leg Pain
01:00 AM
01/08/2023Halie Eatonjene.eaton@yahoo.com(573) 508-837401/16/2023
  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain

Erika
Cash-20.00
west

05:20 AM
01/08/2023Erin Boeckmannerineditor95@gmail.com(573) 645-339601/01/2020
  • Back Pain
  • Neck Pain
01:00 AM
01/08/2023Rosa Stonedejanaba1@yahoo.com(573) 338-496901/23/2023
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain

Jeremiah Luper
Antonio LuperStone

Johns

West
Paid -mc

05:20 AM
01/08/2023Bethany Akyerembakyerem6@gmail.com(573) 220-962101/01/2023
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain

Was a no DrJ

01:00 AM
01/08/2023Wolf Schaeferwolf79070@gmail.com(573) 355-779311/11/2013
  • Back Pain

From Columbia referred to focus on health

01:00 AM
01/08/2023Ann Fitzmaurice19amf01@gmail.com(573) 489-843401/01/2020
  • Neck Pain

Lives in Columbia not interested

01:00 AM
01/08/2023Kelsey Schepperskascheppers@yahoo.com(573) 291-935501/01/2016
  • Sciatica
01:00 AM
01/08/2023Kiley Huttonguitarrocker28@yahoo.com(217) 719-000311/11/2012
  • Back Pain
  • Neck Pain

From combo referred to focus on health

01:00 AM
01/08/2023Pam Beckpambeck01@gmail.com(573) 680-631201/01/2016
  • Back Pain
  • Hip/Leg Pain
01:00 AM
01/08/2023Lily Pirtlelilytaylor0123@gmail.com(573) 561-411311/11/2012
  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Sciatica

Call and check on

01:00 AM
01/08/2023Destiny Schaumburgdestinyschaumburg@icloud.com(573) 280-099701/01/2016
  • Back Pain
01:00 AM
Screening DateNameEmailPhoneAppointment DateRecently Experienced Symptoms:NOTES: (office use only)Appointment Time

Displaying 1 - 25 of 92