Spine Health Assessment

Please select the option that best describes you.

Did you have a severe fall or accident within the last 7 days related to this episode of discomfort?
Yes No
How many chiropractic visits have you had in the past?
1 2-3 4-5 6-8 9-11 12 or more
Cancel
Which of the following surgeries have you had in the past?
Cancel Ok
How many strong pain meds (among the following: Norco, Percocet, Vicodin, Ultram, Tramadol, Hydrocodone, Ultracet, Oxycodone, Dilaudid, MS Contin, MSIR, Oxycontin, see more), in total, have you been taking per day?
< 1/day 1-2/day 3-5/day > 6/day
None