Progress REVIEW FORM 1

Please help us to serve you better by responding to the following questions about your progress.

Name

First Name

Last Name

Consent for review

I hereby give consent to undergo a chiropractic review, evaluation and/or posture image.

1. What were your initial reasons for consulting us?

2. What changes have you noticed since beginning Chiropractic care?

3. Is your general movement / mobility easier?

4. Would you say you are improving at the speed you expected?

5. Are you happy with your overall care at this stage?

6. Would you consider writing us a review?

7. Would you like to continue with care? If yes, how often do you feel you should be adjusted?

8. Would you like any additional information on our Massage, 8WW, Functional Fitness, Supplements or Health Workshops?

9. Is there anyone you would like a New Patient voucher for?

10. Would you like to receive health related emails from us in the future?

I am happy for my feedback and pictures to be used in office, on our social media and/or website:

Yes

On-going consent

A Chiropractic adjustment is considered to be a safe and effective form of therapy for spinal conditions, i.e. vertebral subluxation. A re-evaluation has been performed. If you have any questions about this, please ask your chiropractor.

I have read the above statement and therefore consent to ongoing spinal adjustive chiropractic treatment

Date

YYYY

Start the process →

Progress REVIEW FORM 1

Your health awaits.