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Screening Survey – Good Life Chiropractic

by | May 25, 2022

Displaying 151 - 175 of 175

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
06/04/2023Edna WalkerEmail hidden; Javascript is required.(816) 695-398106/05/202305:30 PM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
06/04/2023James NgugiEmail hidden; Javascript is required.(816) 334-740906/09/202310:00 AM
  • Sciatica
06/04/2023Dion DanielEmail hidden; Javascript is required.(816) 874-793206/05/202311:00 AM
  • Back Pain
  • Hip/Leg Pain
  • Sciatica
06/15/2023Blevins HarnessEmail hidden; Javascript is required.(816) 391-822706/21/202312:15 AM
  • Neck Pain
06/16/2023Debra EdwardsEmail hidden; Javascript is required.(816) 215-313106/21/202302:15 PM

lot of back pain! Suffered from an autoimmune disease that caused a lot of back pain. daughter works at power life & is coming in with her.

  • Back Pain
  • Neck Pain
06/16/2023Katelynn LaneEmail hidden; Javascript is required.(816) 808-575206/22/202301:15 PM
  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
06/21/2023Jason WordEmail hidden; Javascript is required.(816) 699-476906/28/202308:30 AM

sending venmo

  • Back Pain
06/22/2023Dana BoleynEmail hidden; Javascript is required.(816) 482-639806/27/202307:30 AM
  • Back Pain
  • Neck Pain
  • Shoulder/Arm Pain
06/26/2023Daisha RagsdaleEmail hidden; Javascript is required.(816) 651-373806/26/202303:30 PM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
07/05/2023Amanda MiddaughEmail hidden; Javascript is required.(816) 929-400207/13/202305:00 PM
  • Back Pain
  • Neck Pain
07/12/2023Adrianna EbertEmail hidden; Javascript is required.(816) 288-970007/13/202301:30 PM

L&L @ Child Prodigy North with Jadyn. Sent $20 to venmo.

  • Back Pain
  • Neck Pain
07/13/2023Mickayla PendletonEmail hidden; Javascript is required.(816) 209-933407/18/202307:30 AM
  • Back Pain
07/13/2023Theresa FoulkeEmail hidden; Javascript is required.(816) 589-850707/19/202311:15 AM
  • Back Pain
07/13/2023Edwon EdwardsEmail hidden; Javascript is required.(816) 337-549007/19/202309:15 AM
  • Back Pain
07/13/2023Melanie ConeyEmail hidden; Javascript is required.(816) 500-816907/17/202303:30 PM
  • Back Pain
  • Neck Pain
07/13/2023Robbin BlackEmail hidden; Javascript is required.(816) 777-892907/20/202301:15 AM
  • Back Pain
  • Neck Pain
07/13/2023Kelsey JohnsonEmail hidden; Javascript is required.(660) 815-230207/17/202309:15 AM
  • Back Pain
07/13/2023Jennifer FrommerEmail hidden; Javascript is required.(816) 217-868207/21/202303:30 PM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
07/13/2023Cindy DavisEmail hidden; Javascript is required.(816) 550-574807/20/202303:45 PM
  • Back Pain
  • Neck Pain
07/13/2023Tabitha HughesEmail hidden; Javascript is required.(816) 633-205107/27/202303:00 PM

L&L with Jadyn at Blush Boot camp.

  • Neck Pain
  • Sciatica
07/13/2023Carol WoodwardEmail hidden; Javascript is required.(816) 529-565508/03/202304:00 PM

GEHA event

  • Back Pain
  • Neck Pain
07/19/2023Jess ValdezEmail hidden; Javascript is required.(816) 442-004008/21/202303:45 PM

low back pain. L&L with Jadyn at Blush Boot Camp.

  • Back Pain
07/26/2023Amy HawkinsEmail hidden; Javascript is required.(816) 423-160508/02/202302:00 PM

knees dislocate easy. onyx studio l&l w/ jadyn

  • Back Pain
07/27/2023Lydia MartinEmail hidden; Javascript is required.(660) 973-069008/01/202307:15 AM

L&L at Southern Bank. Used to see chiropractor but just moved to the area so looking for new one. Lives in Blue Springs.

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
07/27/2023Victoria DeMarcoEmail hidden; Javascript is required.(816) 284-852308/04/202307:30 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 151 - 175 of 175