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Screening Survey – The Chiro Place – Southaven

by | Jun 16, 2022

Displaying 51 - 75 of 82

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
11/04/2022Crystal Williamscdwilliams1127@icloud.com(662) 902-259711/14/202211:00 AM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Shoulder/Arm Pain
11/05/2022Thomas Long lloutdoorthomaslong@aol.com(901) 646-820011/08/202204:00 PM

Art Crawl

Paid (Debit)

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
11/08/2022Chanyne Bishopkutiepie1988@gmail.com(901) 907-582311/09/202203:30 PM
  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Shoulder/Arm Pain
11/08/2022Sherita Hillsheritahill42@gmail.com(901) 502-980811/10/202311:00 AM

Paid at smith and nephew event mc

  • Shoulder/Arm Pain
11/08/2022Jimmy Kingkingjimmy689@yahoo.com(901) 436-006311/10/202204:00 PM

Paid cash at smith and nephew event mc 11/8

  • Sinus/Allergies
11/08/2022Jamaal Kimblejamaalkimble@gmail.com(662) 934-087211/10/202206:00 PM

Paid debit at smith and nephew event 11/8

  • Back Pain
  • Neck Pain
  • Shoulder/Arm Pain
11/08/2022LaMarcus Streeterldstreeter3@yahoo.com(662) 392-828111/21/202208:30 AM

Hickory Ridge Elementary
Paid via cash app

  • Back Pain
11/10/2022Charles McClurebrandonmcclure@comcast.net(901) 650-731311/14/202203:30 PM

Smith & Nephew M.

  • Back Pain
  • Neck Pain
  • Headaches/Migraines
  • Numbness/Tingling
11/10/2022Deandre Carrollaustinpeay96@icloud.com(901) 450-173711/15/202206:00 PM

Smith & Nephew McKenzie

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Shoulder/Arm Pain
11/16/2022Lakedra Hamptonhampton.lakedra@gmail.com(662) 613-020112/01/202204:00 PM

Needs to pay

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Shoulder/Arm Pain
11/16/2022Naya Washingtonmsnkmarie@yahoo.com(501) 508-381312/08/202208:30 AM

ADFusion
Paid cash app
PO 11/15

  • Neck Pain
11/16/2022Star BrownStarsullivan1@gmail.com(901) 453-516911/29/202206:00 PM

Paid via cashapp
Dfusion
PO

  • Back Pain
  • Neck Pain
11/17/2022Josef Woodyjosefwoody1906@icloud.com(901) 240-344211/23/202209:00 AM

Paid Cash at Southwind Resource Night

  • Back Pain
  • Neck Pain
12/02/2022Malorie Osteenmalorie.osteen@ymcamemphis.org(662) 551-606312/08/202210:30 AM

YMCA Olive Branch
Paid via cashapp 12/2 MC

  • Back Pain
12/07/2022Zoe Brasherzoe.weston0501@gmail.com(901) 734-114212/12/202209:00 AM

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

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Sciatica
12/02/2022Paula Gagnierpgagnier01@gmail.com(626) 644-037001/18/202311:00 AM

01/14/2023
Vision Party
Cymphony
PAID: Cashapp

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Headaches/Migraines
  • Numbness/Tingling
01/17/2023Cheryl Williamswilliamscd1@scsk12.org(901) 301-034201/18/202308:30 AM

Paid via cash app
Robert R church elementary school screening

  • Back Pain
  • Neck Pain
  • Shoulder/Arm Pain
01/18/2023Cymphony Davisogilvier@scsk12.org(870) 316-393801/31/202305:30 PM

Germantown Elem.
1/18/23
PAID: Cashapp
C.D.

  • Back Pain
  • Neck Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
01/30/2023Dorothy Waden/a@gmail.com(901) 603-654802/02/202308:30 AM

Paid via square
Dedicated senior center screening Mc 1/30

  • Back Pain
01/30/2023Jacqueline Jacksonn/a@gmail.com(901) 789-941502/02/202308:30 AM

Paid via square
Dedicated senior center MC 1/30

  • Back Pain
01/30/2023Carolyn Richmondc.richmond720@gmail.com(901) 428-677202/02/202309:00 AM

Paid cash
Dedicated senior center MC 1/30

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
  • Sciatica
  • Shoulder/Arm Pain
02/23/2023Junita Sprypjuanita0866@gmail.com(901) 859-611903/07/202306:30 PM

Dedicated Senior Medical
Cymphony
PAID: Cashapp

  • Back Pain
  • Neck Pain
  • Disc Problems
  • Shoulder/Arm Pain
03/15/2023Roseetta Robinsonroseettarobinson@yahoo.com(901) 486-820603/21/202308:30 AM

C.D.
HUTCHINSON
Paid: SQUARE

  • Back Pain
03/22/2023Miranda Clarktrezshon@gmail.com(662) 548-664204/03/202304:00 PM

Paid via Cashapp
Youth village screening MC

  • Back Pain
  • Sinus/Allergies
  • Hip/Leg Pain
  • Headaches/Migraines
  • Numbness/Tingling
03/25/2023Kimberley Wootenkwooten@kippmemphis.org(901) 229-100003/29/197406:00 PM
  • Back Pain
  • Sinus/Allergies
  • Numbness/Tingling
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 51 - 75 of 82