Chiro Quiz"*" indicates required fieldsHave you visited a chiropractor before? Never I’ve been once or twice. I go a couple times a year for a general check-up. I have previously gone for multiple appoints for a particular issue. All the time. My chiro is my hero.Gender Female MaleWhere are you currently experiencing discomfort or pain? Head / Neck Chest Back / Spine Arms Abdominal Lower Back / Buttock Knees The pain is getting: Better, I want an appointment as a precaution. Much worse (please help). More frequent, there’s hardly a second when I’m not in pain. OtherWhat type of pain is it? Stabbing/shooting Throbbing Achy/dull Burning Pins and needlesSpinal misalignments can make you feel like you need to twist, stretch or crack your neck or back. Do you ever feel the need to crack or pop your neck or lower spine? Yes, it’s the most satisfying feeling. My body cracks and makes weird noises by itself, no assistance needed. No, I hate it when people crack their neck/back. It creeps me out.Have you had any: Sports injuries Motor vehicle/other accidents Surgery/fracturesSelect AllWhat sort of lifestyle do you lead? I smoke like a chimney and consider every hour happy hour. Food is my weakness. Buy me food, make me food or be food and we’ll get along great. I’m fantastic at starting diets. For the first month, I eat well and got to the gym 3 times a week, but then I wrap my lips around a burger and remember what I’m missing out on. I live for the gym. I count macros, only eat whole foods and take every kind of supplement under the sun. Anything to improve my gains.What is making you stressed? My work – I even dream about it... There’s no escape! My spouse – I love them, but they drive me insane. My kids – I swear they’re plotting against me. My social life – the term ‘me time’ is not in my vocabulary. Everything – I’m like a duck. Calm and collected on the surface but paddling like crazy underneath, trying to stay afloat. What stress? I’m as calm as a yogi in savasana.Select AllSpinal health is especially important during pregnancy. Is there any chance that you are pregnant? Yes, I am with child. No, I can barely take care of myself. No, unless there has been a medical breakthrough that says that men can get pregnant.What goals would you like to achieve through seeing a chiropractor? Improved quality of life Healthier immune system Improved performance Pain relief Reduced symptoms Improved function Optimum function Wellness and longevity OtherName*Phone*Email*
