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Screening Survey – Align Chiropractic Clinic Westside

by | Jun 22, 2022

Displaying 51 - 75 of 92

Screening DateNameEmailPhoneAppointment DateRecently Experienced Symptoms:NOTES: (office use only)Appointment Time
02/10/2023Haven Nicholshaven.nichols@doc.mo.gov(314) 368-727602/14/2023
  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Disc Problems
  • Shoulder/Arm Pain
12:00 PM
02/10/2023April Vanovercjlmommy@yahoo.com(573) 619-985801/13/2013
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Sciatica
12:00 AM
02/10/2023Rebecca Piersonrebecca.pierson@doc.mo.gov(573) 826-166302/27/2023
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain

Meniscus tear in lt shoulder
Mc

Es

04:30 PM
02/10/2023Abby Luebbertabby.vinyard@yahoo.com(573) 544-886106/06/2011
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
12:00 AM
02/10/2023Barbara Welschmeyerbarb.welschmeyer@yahoo.com(573) 644-269607/09/2011
  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain

Call and check

01:00 AM
02/10/2023Erin Velardeelea83@yahoo.com(573) 257-133202/13/2023
  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
12:00 PM
02/10/2023Joe Gilbertsonjoseph.gilbertson@doc.mo.gov(563) 542-005809/13/2012
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines

Call and check on

01:00 AM
02/10/2023Derek Hensonderjhenson@gmail.com(573) 631-341607/11/2015
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain
12:00 AM
02/10/2023Rick Wingaterick_w1970@hotmail.com(573) 418-384103/20/2023
  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Numbness/Tingling
12:00 AM
02/10/2023Andrew Schneiderandrew.schneider@doc.mo.gov(636) 357-475603/01/2023
  • Neck Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain

Visa

09:00 AM
02/10/2023Jessica Overstreetjessicamooneylmt@gmail.com(573) 552-209302/14/2023
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica

L5 enlarged

04:35 AM
02/10/2023Mary Koestnermlkoestner67@gmail.com(573) 821-370406/12/2010
  • Hip/Leg Pain

Call to check on
Seed and feed

01:00 AM
02/10/2023Melissa Nicholsmjbn122@gmail.com(573) 353-815402/21/2023
  • Shoulder/Arm Pain

Left shoulder, mild scoliosis
Cash- LW

03:30 AM
02/10/2023Julie Campbellbridg.pax@gmail.com(816) 645-431302/21/2023
  • Back Pain
  • Neck Pain
  • Sinus/Allergies

C4 to c6 took part of the herina
Lower back pain standing long time
Card LW

05:25 AM
02/10/2023Klarissa DeOrnelliskshefit@yahoo.com(573) 645-913002/13/2023
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain

Seed and feed
Es
Card paid

09:00 AM
02/11/2023Kaitlyn Boozerkaitlynboozer2@gmail.com(636) 293-734204/06/2023
  • Neck Pain
  • Headaches/Migraines

Scoliosis
Maybe only in town for school

12:00 AM
02/24/2023Sherry Goldenksgold199@hotmail.com(913) 314-234101/01/2016
  • Back Pain
  • Neck Pain
  • Disc Problems
  • Numbness/Tingling
  • Sciatica

In wheelchair
Numbness and tingling in hands and feet

Give them a call

01:00 AM
02/24/2023Sara Krullszkrull51@gmail.com(573) 645-598802/02/2013
  • Back Pain
  • Numbness/Tingling
  • Sciatica

Give her a call

01:00 AM
02/24/2023Melissa Cookmmkjmg@gmail.com(555) 555-555503/09/2013
  • Neck Pain
  • Headaches/Migraines
  • Numbness/Tingling
01:00 AM
02/24/2023James Pettitjamespettit519@gmail.com(573) 680-343803/06/2023
  • Back Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain

Sharp pain in left mid back
Fell off of a bucket

05:20 AM
02/24/2023Mikaila Heesmikailamaehees17@gmail.com(573) 480-851501/01/2023
  • Hip/Leg Pain

9 months

01:00 AM
02/24/2023Will Rejanvtheblindace94@gmail.com(417) 631-757001/01/2023
  • Sinus/Allergies
  • Headaches/Migraines

Potential gave card
Did not schedule

01:00 AM
02/24/2023Samaria Jonessamariaj0404@gmail.com(573) 536-120701/01/2023
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Ear Aches
  • Headaches/Migraines

Potential, did not schedule
AS

01:00 AM
02/24/2023Damian Cottondamianc1800@icloud.com(618) 419-437201/01/2023
  • Back Pain
  • Sinus/Allergies
  • Headaches/Migraines

Potential, did not schedule
AS

01:00 AM
02/25/2023Wanda Mckinziemckinzie2@att.net(660) 221-713101/01/1988
  • Sinus/Allergies
  • Hip/Leg Pain
01:00 AM
Screening DateNameEmailPhoneAppointment DateRecently Experienced Symptoms:NOTES: (office use only)Appointment Time

Displaying 51 - 75 of 92