Worksheet

1. Inability to perform your normal job without increased pain.
2. Back and leg pain
3. Neck and arm pain
4. Have been told NOT to see a chiropractor from someone that has never been to a doctor of chiropractic or has had no training in chiropractic case management.
5. Complaints of frequent headaches
6. Chronic complaints of neck pain and stiffness
7. Chronic complaints of back pain with difficulty in bending , sitting and/or lifting.
8. Unsuccessful previous neck or back treatment especially with recurrent or worsening symptoms.
9. Have been told with previous care that "nothing was found" or the test results are "normal" and nothing except pain medication has been offered to you.
10. Progressive stiffness in the neck or the low back upon arising from sleep.
11. Have constant pain in the spine and just want to make the pain stop.
12. Are in too much pain to exercise.
13. Are interested in information to prevent future health care conditions
14. Are interested in health care that takes care of your health rather than focusing the majority of the efforts toward disease management.
15. Are ready to take the responsibility to make your health better with a Doctor-Coach relationship so that you can reach the goals that you want to achieve.

If you have one or more of the above problems, you may benefit from a visit to the Family Chiropractic Center. For an appointment with Family Chiropractic, please call the closest Family Chiropractic Center listed above.

If we accept you as a patient, you will be very pleased with the efforts we display in providing you care.