Indicate by drawing on the image below, your current areas of discomfort.
Draw, circle, or cross the areas, including any symptoms of headache or migraine.
Our mission is to educate as many people as possible about the potential benefits of chiropractic care.
Therefore to do this we need your help.
Does anyone come to mind?
Indicate under the column your improvement to date.
For SIGNIFICANT Improvement: ++
For Improved: +
For no noticed change: -
Key to Questionnaire