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Screening Survey – The Chiro Place – Southaven

by | Jun 16, 2022

Displaying 76 - 82 of 82

Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:
03/25/2023Priscilla Blackmonpblackmon@alliance.hs.org(901) 409-402803/30/202303:30 PM

A. S.
Kipp Health Fair
PAID SQUARE

  • Back Pain
  • Neck Pain
  • Sciatica
03/25/2023Olivia Holmeslivholmes1@gmail.com(901) 691-066404/03/202303:30 PM

A.S.
KIPP HEALTH FAIR
PAID SQUARE

  • Sinus/Allergies
  • Ear Aches
  • Hip/Leg Pain
04/18/2023Sandra Russellsrussell189@gmail.com(901) 568-472304/20/202310:30 AM

Bell South Retirement Group
C.D.
PAID:SQUARE

  • Back Pain
  • Neck Pain
  • Hip/Leg Pain
  • Sciatica
04/18/2023Evelyn Merriweatherewarem51@gmail.com(901) 237-049404/25/202304:30 PM

BellSouth Retirement
PAID :SQUARE (paid @ 11:15)
C.D.

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
  • Shoulder/Arm Pain
04/18/2023Beverly Boydbjanisbb@gmail.com(901) 608-209904/24/202309:00 AM

AS
Paid Cash

  • Neck Pain
  • Numbness/Tingling
  • Shoulder/Arm Pain
04/18/2023Linda Millermiller.stevenson.linda599@gmail.com(901) 949-717804/25/202303:30 PM

BellSouth Retirement
A.S.
PAID: SQUARE (paid at 12:46)

  • Back Pain
  • Hip/Leg Pain
  • Disc Problems
04/18/2023Evelyn Merriweatherewarem51@gmail.com(901) 237-049404/27/202311:00 AM

BellSouth Ret.
AS

  • Back Pain
  • Hip/Leg Pain
  • Sciatica
  • Shoulder/Arm Pain
Screening DateNameEmailPhoneAppointment DateAppointment TimeNOTES: (office use only)Recently Experienced Symptoms:

Displaying 76 - 82 of 82