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Home
About Us
Our Team
Facilities and Services
Fees
Success Stories
Workshops
NutriDyn Nutritional Support
Affiliates
Chiropractic
Chiropractic
New Patients
8 Weeks to Wellness
Massage
Fitness
8WW
Functional Fitness
Special Offers
Contact Us
Progress check 2
Please help us to serve you better by responding to the following questions about your progress.
Name
*
First Name
Last Name
1. Would you consider writing us a review?
2. What changes have you noticed since beginning Chiropractic care?
3. On a scale of one to ten, rate the level of your overall improvement so far:
No Change
1
2
3
4
5
6
7
8
9
10
Major Change
4. How do you find your Chiropractic adjustments help you?
5. What other improvements have you noticed in your general health?
6. How many days per week do you exercise?
7. How would you rate the care, concern and efficiency shown by our team?
Very Poor
1
2
3
4
5
6
7
8
9
10
Great
8. Are you happy with your overall care at this stage?
9. Please tick if you are experiencing any of the following:
Increased energy
More balanced
Feeling stronger
Feeling more alert
Able to relax better
Better concentration
10. Please tick if any of the following activities are easier:
Sleeping
Walking
Driving
Sitting
Standing
Working
Bending/Lifting
Sports
11. Is there anyone you would like to recommend for Chiropractic care?
Consent
*
A Chiropractic adjustment is considered to be a safe and effective form of therapy for spinal conditions i.e. vertebral subluxation. A thorough examination, with or without x-rays has been performed to minimise any risk to you. If you have any questions about this please ask your practitioner.
I have read the above statement and therefore consent to ongoing spinal adjustive Chiropractic treatment.
Date
*
MM
DD
YYYY
Thank you!