SYMPTOMS QUESTIONNAIRE
SYMPTOMS OF SPINAL MISALIGNMENT QUESTIONNAIRE
"The nervous system controls and coordinator all organs and structures of the human body." (Gray's Anatomy 29th ED., page 4). Misalignments vertebrae and disc may cause irritation to the nerves which could affect the area listed. Please help us help you by placing a check mark in the appropriate box under the "Possible Effects" column to indicate your symptoms.