Subjective Progress Report (Page 2 of 2) in pdf

Subjective Progress Report Page 2

6. Please note if you have noticed any improvement in the following:

____ Digestion

____ Energy Level

____ Elimination

____ Sleeping

____ Breathing

____ Strength

____ Composure

____ Stamina

7. Have we been attentive to your specific concerns? Yes___ No___

8. Is there anything you think the doctor should know concerning your condition? __________________________

__________________________________________________________________________________________

9. How often are you doing prescribed exercises? Are they helping? ___________________________________

__________________________________________________________________________________________

10. Would you tell one person about the benefits of chiropractic? Yes___ No___

If yes, then who do you wish was coming here? ________________________________________________

121. Given your current understanding of chiropractic care and the results you have achieved, what are your goals

through chiropractic care?

____ Just pain relief

____ Being pain free, plus improved Spinal structural ability & wellness

____ Pain relief, improved stability, plus long term increased vitality

12. Do you understand why chiropractic is so important for children? Yes___ No___

Why? __________________________________________________________________________________

_______________________________________________________________________________________

13. Have your children been checked? Yes___ No___

Subjective Progress Report Page 2