Chicago Chiropractic

A Unique, Multidisciplinary Approach to Pain Management

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MSWD


















Auto AccidentWorkman's Compensation


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Constantly (76%-100% of the time)Frequently (51%-75% of the time)Occasionally (26%-50% of the time)Intermittently (1%-25% of the time)

SharpDullDiffuseAchyBurningShootingStiffNumbTinglySharp with motionShooting with motionStabbing with motionElectric like with motionOther


NoYes




Getting WorseStaying the SameGetting Better

Not at allA little bitModeratelyQuite a bitExtremely

Not at allA little bitModeratelyQuite a bitExtremely

ChiropractorER physicianMassage TherapistNeurologistOrthopedistPhysical TherapistPrimary Care PhysicianNo oneOther

ExcellentVery GoodGoodFairPoor

StenuousModerateLightNone

Drink AlcoholSmokeTake illicit drugs




NoYes

NoYes

Rheumatoid ArthritisHeart ProblemsDiabetesCancerLupusALS

PAYMENT OF THE FIRST VISIT IN FULL IS REQUIRED



NoYes

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