Screening Survey – Align Chiropractic Clinic Westside

by joeln_ID | Jun 22, 2022

Displaying 76 - 92 of 92

Screening Date	Name	Email	Phone	Appointment Date	Recently Experienced Symptoms:	NOTES: (office use only)	Appointment Time
02/25/2023	Toby Morris	alignchiropractic@gmail.com	(573) 257-0163	01/01/1978	Sinus/Allergies		01:00 AM
02/25/2023	Cindy Carvar	carvarcindy@hotmail.com	(573) 821-1654	01/01/1973	Back Pain Headaches/Migraines		01:00 AM
02/25/2023	Mary Anne Spencer	7spenhens@gmail.com	(573) 826-1460	01/01/1978	Back Pain Neck Pain Hip/Leg Pain Headaches/Migraines		01:00 AM
02/25/2023	Kristina Schulte	kristinaschulte2018@gmail.com	(573) 418-7799	03/01/2023	Sciatica		12:00 PM
02/25/2023	Gene Atkinson	none@gmail.com	(573) 635-7493	01/01/2009	Back Pain Sciatica		01:00 AM
02/25/2023	Ashton Buchholz	none@gmail.com	(573) 826-7757	01/01/2000	Sinus/Allergies	Kid dad wouldn’t give number	01:00 AM
02/25/2023	Jill Peters	petersj4@yahoo.com	(573) 353-2126	02/25/2023	Back Pain Sinus/Allergies Sciatica	Was not having it is a nurse and her significant other was a pt Didn’t sign and does not want to be contacted	01:00 AM
02/25/2023	Reshonda Peterson	mobleyroo@gmail.com	(573) 418-6560	08/14/2007	Back Pain Sinus/Allergies Ear Aches Hip/Leg Pain Headaches/Migraines Sciatica	Arthritis in spine	12:00 AM
02/25/2023	Steve Price	sprice809@hotmail.com	(573) 680-1833	03/02/2023	Back Pain Neck Pain Numbness/Tingling	Neck pain arthritis East side	02:45 PM
04/22/2023	Brenda Manasco	brenk719@icloud.com	(417) 861-0808	05/03/2023	Neck Pain		05:20 AM
05/16/2023	John Doe	khgchfcyfchgcd@gmail.com	(573) 666-6666	03/03/2023	Back Pain		01:00 AM
05/16/2023	Chlora Myers	n2law56@hotmail.com	(678) 458-9618	05/16/2023	Sinus/Allergies Hip/Leg Pain	Call and follow up	01:00 AM
05/16/2023	Christina Rauba	clrauba@gmail.com	(832) 723-5371	05/25/2023	Back Pain Neck Pain Headaches/Migraines Shoulder/Arm Pain	Broken vertebrae in the lower back And we could get her daughter in	12:00 PM
05/16/2023	Laronda Cifuentes	larondamcifuentes@gmail.com	(573) 284-9229	05/22/2023	Neck Pain Headaches/Migraines Numbness/Tingling Sciatica Shoulder/Arm Pain	Tingling in the shoulder blade Car accident neck injury still has pain	12:00 AM
05/18/2023	Lindsey Crouse	lil_pohlmann@hotmail.com	(573) 259-7125	05/31/2023	Back Pain Neck Pain Sinus/Allergies Hip/Leg Pain Headaches/Migraines Numbness/Tingling Sciatica		05:20 PM
05/18/2023	Makenna Kesel	mekennakesel@gmail.com	(573) 291-1214	05/25/2023	Back Pain Sinus/Allergies Hip/Leg Pain Sciatica		05:20 PM
04/22/2023	Julia Gabbard	italwaystakes2@gmail.com	(573) 480-5888	06/06/2023	Back Pain Neck Pain Sinus/Allergies Hip/Leg Pain Headaches/Migraines Numbness/Tingling Sciatica		05:20 PM
Screening Date	Name	Email	Phone	Appointment Date	Recently Experienced Symptoms:	NOTES: (office use only)	Appointment Time