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Please Select Your Referring Meridian Physiotherapist
Dr Rhiannon Hutton, DC, MAOM
Dr Andrew Buser, DC, CSCS
Joey Zimet, Meridian Exercise Therapist
No Referring Physiotherapist
Please list your chief complaint and any changes you have experienced since you began this or any other treatment. Has the problem got better or worse or changed?
What are you doing for the chief complaint? And how often are you doing it? Ie. MPT exercises daily, following or not following diet and herb recommendations.
Are you taking any new medications or having any new problems?
Do you have any of the following? If so, please list and let your Primary Care Physician know.
High Blood Pressure
Bowel or Bladder Problems
If you checked any of the above, please describe.
Meridian Category 1- Please select all of the following that apply.
Quiet Voice or A Dislike of Speaking
Frequent Colds, Flu, or Allergies
Meridian Category 2- Please select all of the following that apply.
Frequent Abdominal Bloating, Gas, or Difficulty Digesting Food
Pain in the Epigastrium (The area between your belly button & heart)
Frequent Loose Stools
Meridian Category 3- Please select all of the following that apply.
Feeling of Fullness or Pain in the Chest
Difficulty Falling Asleep
Palpitations (A feeling that your heart is beating hard)
Anxiety or Panic Attacks
Meridian Category 4- Please select all of the following that apply.
Frequent Desire to Lie Down & Curl Up
Frequent Runny Nose, Nasal Congestion, or Nose Bleeds
Fatigue or Depression
Difficulty Staying Asleep
Frequent Urinary Tract Infections
Meridian Category 5- Please select all of the following that apply.
Mood Swings or Stress
Hernia or Erectile Dysfunction
Pain or a Feeling of Fullness Below the Ribcage
Gallstones or Difficulty Digesting Fatty Foods
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