Primary reason for appointment?
Your general condition of health?
Describe any serious illnesses, injuries, or surgeries
Do you have frequent headaches?
Describe any persistent feelings of sadness, depression, guilt or anxiety
Are you currently under the care of a doctor or chiropractor?
What do you do for relaxation?
List medications are reasons for taking them
List dietary supplements and amounts taken
Any other facts or information that might help us to understand your current condition better?
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