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Patient Questionnaire - Need Chiropractor?

Do you need a chiropractor?

Answer our short and easy questionnaire below. Pick the one statement that most closely describes your problem.

PAIN INTENSITY

  1. I have no pain.
  2. I can tolerate the pain without drugs.
  3. I can manage my pain with the help of drugs.
  4. Pain relievers give me no comfort.

LIFTING

  1. I have no pain when lifting.
  2. I have slight pain when I lift.
  3. Pain prevents me from lifting heavy objects.
  4. I can only lift light to moderate objects.
  5. I can barely lift anything.

     

STANDING

  1. I can stand up for extended periods.
  2. I cannot stand for more than one hour without pain.
  3. I cannot stand for more than 30 minutes without pain.
  4. I cannot stand at all without pain.

HEADACHES

  1. I have no headaches.
  2. I have slight headaches.
  3. I have moderate to severe headaches.
  4. I have headaches all the time.

SOCIAL LIFE

  1. My social life is normal.
  2. My social life is normal, but with slight pain.
  3. My social life is limited by pain.
  4. Pain prevents me from having a social life.

Total up your score. If your score is 3 or above, please give our office a call @952-931-9867 to set up an initial consultation. We look forward to assisting you in achieving better health through chiropractic.

Contact Us by calling 952-931-9867 or using the form below

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Our Hopkins, Minnesota office conveniently serves Minneapolis, Minnetonka, Eden Prairie, St. Louis Park, Bloomington, and Edina
Copyright 2018 by Schumacher Chiropractic 

Content copyright 2018. Schumacher Chiropractic Clinic Hopkins, P.A. All rights reserved. All material on this website is copyrighted by Schumacher Chiropractic Clinic Hopkins, P.A., except for some material that is copyrighted by others and used here by permission. Copyrighted material may not be copied, reproduced or otherwise used for commercial purposes without the written permission of the copyright holder. Designated trademarks and brands of any organizations mentioned herein are the property of their respective owners in the United States, Canada, and/or other countries. The products and the claims made about specific products on this web site have not been evaluated by Schumacher Chiropractic Clinic Hopkins, P.A. or the United States Food and Drug Administration and are not approved to diagnose, treat, mitigate, cure or prevent disease. The information provided herein is for general information purposes only and is not intended as advice from your physician or other healthcare professional or any information contained on or in any product label or packaging. You should not use the general information on this web site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting with any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a medical issue or health problem.

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