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Screening Survey – Riggs Chiropractic – Riverton

by | May 20, 2022

Displaying 26 - 50 of 56

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
09/13/2022Kylie Rogerskyliemrogers@gmail.com(620) 304-175909/14/202209:00 AM

Mbp, ear aches 1/2 month, everyday, left foot numbness, shoulder pain both

  • Back Pain
  • Ear Aches
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
09/16/2022Misty Scottmntgrl7708@yahoo.com(918) 533-375309/19/202209:45 AM

Lbp (herniated disc), 1/month headaches, both shoulders- versititis,

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
09/16/2022Michael Robersonmrdad_1959@yahoo.com(918) 961-292909/19/202211:15 AM

Becca- Quapaw fm - Lbp, neck pain, right hip, lower lumbar disc problems, right leg, both shoulders

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
09/20/2022Danielle Drakeddrake121@hotmail.com(417) 438-307909/23/202211:15 AM

Becca - 24 Hr Elite Hip pain - left, neck left, 2/wk headaches, numbness in hands and feet,

  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
10/07/2022Shirley Eilandshirleyisland1@gmail.com(620) 249-607510/13/202210:00 AM

Becca- Quapaw fm, Back pain-has had back surgery & is experiencing right hip pain,

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Sciatica
10/13/2022Angie Kellyangelakelly2022@gmail.com(539) 577-902610/19/202210:00 AM

Becca- Quapaw Fitness center, Severe spinal stenosis c5 & 6, arms and legs numbness,

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
10/13/2022Ray Kellykellyrayall@gmail.com(918) 608-945910/19/202209:45 AM

Becca-Quapaw fitness, mid-lbp,

  • Back Pain
11/02/2022Louis Vargasiamlv3@hotmail.com(417) 312-768111/03/202209:15 AM

Lbp, sciatica- right leg tingling & pain all the way down, neck pain,

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
11/08/2022Tracee Kerrtwilson4669@gmail.com(918) 325-042911/16/202209:00 AM

Becca- Weston’s, Everywhere bp, ring, both hip legs, migraines a couple a month, cpl headaches, feet, radiates on right side, right shoulder

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
11/08/2022Larry Wilsontwilson4669@gmail.com(918) 919-252711/16/202209:00 AM

Becca- Weston’s, Neck pain, stress knots, scoliosis, shoulders,

  • Neck Pain
  • Numbness/Tingling
11/09/2022Kristi Williamskristi.eckler72@gmail.com(417) 850-076211/21/202202:45 PM

Becca- JBirds- PD- Clover, Lbp, headaches/2wk, n & t in feet, sciatica-radiates-left

  • Back Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
11/09/2022Morgan Queripelmqueripel2@gmail.com(417) 771-704911/15/202202:45 PM

Becca-JBirds- lbp & sides, earaches, constant hip or leg pain, chronic migraines, n& t in feet,

  • Back Pain
  • Ear Aches
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
11/10/2022Mary Mitchellgmitchell@ckt.net(620) 719-621012/07/202202:00 PM

Ubp, sciatica left side into foot, shoulder,

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Headaches/Migraines
  • Sciatica
11/11/2022Abbie Knoxabigail@mkelloggcpa.com(417) 569-751611/21/202212:15 PM

Hip-right, headaches 2/wk, legs fall asleep fast,

  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
11/14/2022Will Mallattwill.mallatt@gmail.com(620) 474-518311/17/202209:00 AM

Becca- Riverton High School- Sciatica-right leg, occasionally neck pain,

  • Neck Pain
  • Hip/Leg Pain
  • Sciatica
11/15/2022Jordan Mortonjordancrowder54@gmail.com(417) 291-941711/28/202204:15 PM

Becca- riv high- Back pain, mid & upper back, sciatica-left side, preg. 10 weeks

  • Back Pain
  • Headaches/Migraines
  • Sciatica
11/15/2022Tiffany Longashton.cook6@gmail.com(417) 952-074601/02/202202:45 PM

Becca- riv high- hips, sciatica-right side, X-ray(3 yrs ago) shows spine turned a bit

  • Back Pain
  • Ear Aches
  • Hip/Leg Pain
  • Sciatica
11/15/2022Sarah Haskinsscintillating.moniker@gmail.com(417) 629-229111/30/202204:00 PM

Becca- riv high- lbp, breast reduction, neck, migraines, chronic, sciatica-right,

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Sciatica
11/15/2022Rayanna Leerlee@usd404.org(417) 317-355311/22/202207:00 AM

Becca- riv high school, neck, sciatica-radiates right, right shoulder arthritis

  • Neck Pain
  • Sciatica
11/22/2022Kelsey Lewiskrlewis10@gmail.com(417) 434-107912/01/202211:30 AM

Becca- 5star nutrition, Left shoulder,

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
11/22/2022Cheron Myerscheronmyers@yahoo.com(417) 499-380011/30/202202:45 PM

Becca- JBirds, pd-clover, shoulder pain, ubp, ear aches, sciatica-right tingling, deg disc,

  • Back Pain
  • Ear Aches
  • Hip/Leg Pain
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
11/29/2022Monica Millermmiller@srmhw.org(620) 704-137912/07/202204:15 PM

Becca -mid lbp, hip pain, leg pain, shoulder, sits all desk all the time

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
11/29/2022Ryan Phillipsrjp5697@outlook.com(417) 456-812112/06/202207:30 AM

Becca- lbp, leftleg, headaches cpl/week,

  • Back Pain
  • Hip/Leg Pain
  • Headaches/Migraines
11/29/2022Sydney Larsonselarson98@yahoo.com(417) 236-694612/07/202211:45 AM

Becca- Lbp,

  • Back Pain
11/30/2022Jake Kanmorejakekanmore@gmail.com(620) 268-998312/08/202207:00 AM

Alexis- often sinus issues

  • Sinus/Allergies
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 26 - 50 of 56