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.
- I have no pain.
- I can tolerate the pain without drugs.
- I can manage my pain with the help of drugs.
- Pain relievers give me no comfort.
- I have no pain when lifting.
- I have slight pain when I lift.
- Pain prevents me from lifting heavy objects.
- I can only lift light to moderate objects.
- I can barely lift anything.
- I can stand up for extended periods.
- I cannot stand for more than one hour without pain.
- I cannot stand for more than 30 minutes without pain.
- I cannot stand at all without pain.
- I have no headaches.
- I have slight headaches.
- I have moderate to severe headaches.
- I have headaches all the time.
- My social life is normal.
- My social life is normal, but with slight pain.
- My social life is limited by pain.
- 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.