Chicago Chiropractic

A Unique, Multidisciplinary Approach to Pain Management

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    MSWD


















    Auto AccidentWorkman's Compensation


    012345678910
    012345678910
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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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