Stress Test

!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
Nature of Injury
!
!
!
Have you ever had same condition?
!
!
Have you ever been under chiropractic care?
!
!
!
Do you have health insurance?
!
!
!
!
!
Have you been treated for any conditions in the last year?
!
!
Is there a chance that you are pregnant?
Have you had X-rays taken?
!
!
!
Broken bones?
!
Been hospitalized?
!
Been in auto accident?
!
Had Sprains/Strains?
!
Been struck unconscious?
!
Had surgery?
!
!
Do you experience pain every day?
Do your symptoms interfere with daily life?
Does pain wake you up at night?
Are your symptoms worse during certain times of the day?
Do changes in weather affect your symptoms?
Do you wear orthotics?
Do you take vitamin supplements?
!
Alcohol
Coffee
Tobacco
Drugs
Exercise
Sleep
Appetite
Soft Drinks
Water
Salty Foods
Sugary Foods
Artificial Sweeteners
Have you ever suffered from:

Please do not submit any Protected Health Information (PHI).

Error!


    Results

    If you checked any of the above items, then you could be suffering from excessive stress, structural misalignment or pinched nerves. We can help you because we gently treat your body, naturally, without drugs to remove the stress and imbalances that cause health problems.

    If you would like to discuss your symptoms and get information on treatment options then please contact us or let us know the best time to contact you.

    Office Hours

    Roswell Office

    Monday  

    By Appointment Only

    Tuesday  

    By Appointment Only

    Wednesday  

    By Appointment Only

    Thursday  

    By Appointment Only

    Friday  

    Closed

    Saturday  

    Closed

    Sunday  

    Closed

    Fowler/Integrated Chiropractic & Rehabilitation Clinics

    770-641-8283