Chiropractor Posture Chart

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Chiropractic Posture Chart 
Date:
Doctor: _________________________________________
Patient’s Name:
Ref #: __________________________________________
Date of Birth:
Age:
Gender:
Male
Female
Insurance Details: ________________________________________________________________________________
 
Standing Posture
Scoring
Body Parts
L
R
Head
Neck
Shoulders
Upper Back
Lower Back
Spine
Torso
Abdomen
Hips
Knees
Ankles
 
 
Prone Posture
Supine Posture
Scoring
Scoring
Body Parts
Body Parts
L
R
L
R
Head
Head
Neck
Neck
Shoulders
Shoulders
Upper Back
Upper Back
Lower Back
Lower Back
Spine
Spine
Torso
Torso
Abdomen
Abdomen
Hips
Hips
Knees
Knees
Ankles
Ankles
 
 
 
 

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