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Screening Survey – The Chiro Place – Bartlett

by | Jun 16, 2022

Displaying 26 - 50 of 76

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
09/28/2022Tiffany Williamstiffany10012004@yahoo.com(901) 512-027110/11/202210:30 AM

SCS Bonds Building
PAID Debit

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
10/01/2022Darlene Hilldarlene.hill@ymail.com(901) 334-748310/06/202209:00 AM

Rosemary church
PAID debit

  • Back Pain
10/07/2022Jamil Matthewsjamil.matthews@outlook.com(901) 340-177410/19/202209:00 AM

Lakeside Conference

PAID (debit)

  • Hip/Leg Pain
10/07/2022Marlanna Mitchellmitchell.marlanna@gmail.com(901) 598-004810/11/202208:30 AM

Lakeside Conference

Paid (debit)

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
10/08/2022Sheena Christynecole.alexis@att.net(901) 289-610510/13/202204:00 PM

New patient Bartlett paid kasey

Connect center

  • Back Pain
10/08/2022Ashley Hernandezhernandezmashley@gmail.com(901) 570-627310/13/202204:00 PM

cash app
Connect center
New patient bre

  • Back Pain
10/08/2022Roshunda Yancyroroy28@yahoo.com(901) 279-067010/11/202209:00 AM

Connect center

New patient Bre

Paid with square

  • Back Pain
  • Sinus/Allergies
10/08/2022Carrie Wrightmrscarriewright@yahoo.com(901) 358-592910/17/202203:00 PM

New patient Shawn
Connect center
Paid Square

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
10/08/2022Damon Williamsdamonwill78@gmail.com(202) 345-433310/11/202209:00 AM

Connect center

New patient

  • Neck Pain
10/13/2022Dennis McDanieldennissmac55@gmail.com(901) 558-874810/18/202206:00 PM

Np bre
Cash app paid
Aspen dental

  • Back Pain
10/13/2022Andrew Griffinajgriffinjr@gmail.com(773) 715-966110/18/202206:00 PM

Np bre

Aspen dental

Square paid

  • Back Pain
10/19/2022Morgan Wileymorganwiley88@gmail.com(678) 525-904710/26/202204:00 PM

Power Center High School
PAID AO

  • Neck Pain
  • Headaches/Migraines
10/20/2022Roderick Glassroderickglass@gmail.com(901) 859-108311/07/202210:30 AM

SW Parent Night
PAID debit AO

  • Back Pain
  • Hip/Leg Pain
  • Disc Problems
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
10/22/2022Amber Thomasmsamber26@yahoo.com(901) 279-227010/25/202206:00 PM

Soulsville charter school event

Np kasey

Paid cash

  • Back Pain
10/22/2022Jacque Fieldsjacquerowe5@gmail.com(616) 308-004211/01/202206:00 PM

Soulsville charter school

Np bre

Cash app paid

  • Numbness/Tingling
10/26/2022Laderrrick Williamslwilliams@kippmemphis.org(901) 591-561111/10/202206:00 PM

Kipp health fair

Np amber

Cash app paid

  • Neck Pain
10/26/2022Linda Harriswomenrock2usa@gmail.com(336) 653-170011/01/202204:00 PM

Kipp health fair

Amber NP

Cash app paid

  • Back Pain
  • Neck Pain
  • Shoulder/Arm Pain
10/26/2022Mary Watsonmarclyw@gmail.com(901) 596-012011/10/202206:00 PM

Kipp health fair

Np kasey

Paid debit

  • Numbness/Tingling
10/27/2022Lenita Fisherlenita.fisher@gmail.com(901) 679-515611/08/202206:00 PM
  • Neck Pain
10/27/2022Rashea Walkerrashea.hayslett@yaho.com(901) 608-593611/03/202211:30 AM

UT Health Fair

Sk
Paid cashapp

  • Back Pain
10/27/2022Terrance Tillerterrancetiller@gmail.com(402) 319-467811/08/202210:30 AM

Collierville Business Expo

PAID Debit

  • Back Pain
  • Headaches/Migraines
  • Sciatica
10/31/2022Deidra Jonesdeidra.jones89@gmail.com(213) 503-466911/08/202203:30 PM

FTK Thrill A Ween Vendor

PAID Debit

  • Back Pain
  • Hip/Leg Pain
11/08/2022Regina Hartsuckhartsuckr@scsk12.org(601) 937-655411/15/202206:00 PM

Hickory Ridge Elementary
Paid VIA CashApp $30
PO 11/8/22

  • Back Pain
12/07/2022Torre Thomastorre.thomas@youthvillages.org(901) 438-238812/10/202211:00 AM

Paid for np appt on 12/7 via cashapp - youth villages wellness fair - 12/7 HS

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
12/07/2022Tyeshia Spanntyeshia.spann@gmail.com(601) 573-539201/04/202308:30 AM

Paid for np appt on 12/7 via cashapp - youth villages wellness fair - 12/7 HS

  • Back Pain
  • Neck Pain
  • Ear Aches
  • Headaches/Migraines
  • Disc Problems
  • Shoulder/Arm Pain
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 26 - 50 of 76