Welcome! We’re Glad To See Your Back!Tell us a little about how your feeling today and we will see how we can help! Patient Sign-In: * Patient ID (Last 4 of phone number) Reason For Visit: * Chiropractic Chiro +PT Weight Loss Massage Other Primary Complaint: * Head Neck Upper Back Mid-Back Lower Back Left Shoulder Right Shoulder Left Hand Right Hand Left Wrist Right Wrist Left Hip Right Hip Left Knee Right Knee Left Ankle Right Ankle Left Foot Right Foot Other Current Pain Scale: 1 2 3 4 5 6 7 8 9 10 Secondary Complaint: Head Neck Upper Back Mid-Back Lower Back Left Shoulder Right Shoulder Left Hand Right Hand Left Wrist Right Wrist Left Hip Right Hip Left Knee Right Knee Left Ankle Right Ankle Left Foot Right Foot Other Pain Scale: 1 2 3 4 5 6 7 8 9 10 Any Additional Notes You'd Like The Doctor To Be Aware of? Thank you! We will be with you shortly!