Adult Clinical Information
It surprises many people when they discover chiropractic doctors don’t treat symptoms; instead, they find the underlying cause(s) of your ache, pain or condition, and help your body to heal. Chiropractors understand that symptoms may indicate that there is something not functioning correctly in the body, or they may be good warning signs from an optimally functioning body that is being overstressed. People present to this clinic in various stages of health or health decline.

If you are experiencing symptoms, then please describe these as fully and informatively as you can by answering the following:

What is your name? *
Your answer
What is your presenting concern or problem? *
Your answer
When did this pain/problem start?
MM
/
DD
/
YYYY
What (if anything) triggered the pain/problem?
Your answer
Have you had previous episodes of this problem?
If you have had this problem before, how many times (roughly) has it occurred?
Your answer
How would you describe the pain?
Is the pain affecting other areas of your body?
If yes, where?
Your answer
Is the condition getting worse?
What brings on your condition or makes it worse?
Your answer
What relieves your condition or makes it feel better?
Your answer
Is this symptom interfering with
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