Essential Downloads for Physical Therapy Chiropractic Nutrition

Step #1
All new patients need to fill out the following forms before you come:

C-01 Rehab Registration Form
C-02 Health History and Review of Systems Form

o If you are seeking our help for relief of pain go to step #2.
o If not then you are finished with your forms. Bring accomplished forms on your initial office visit.

Step #2
If you are seeking our help for relief of pain you then fill out:

C-03 Pain Diagram Form

o Go to step #3.

Step #3
You should have just completed step #1 and step #2.
Now click on the following areas of the body and fill out the appropriate questionnaire form if applicable to your area of concern.

Note: Please select what is applicable to you. Ex. If you have neck pain, only fill out C-04. If you have back pain, fill out C-05. If you have more than one condition, fill out the appropriate form for your condition

C-04 Neck Questionnaire
C-05 Lower Back Questionnaire
C-06 Knee Questionnaire
C-07 Shoulder Questionnaire

C-09 Headache Questionnaire
C-10 Arm, Elbow, Wrist, Hand Questionnaire

If you need to lose weight or have a nutritional problem proceed to step #4.

Step #4 Nutrition 

Food Journal fill out for 2-4 typical days.  A few regular week days and weekends are fine. Every thing you eat and the amount needs to be recorded.  For example if you had French fries please include if they were baked or from fast food, the size of the order, and if you used ketchup with the fries.

n-01 Food Journal

 detailed symptom survey specific for nutritional deficiencies.  Mark the box with a 1 if you experience that symptom a few times per year.  Mark a 2 if you experience that symptoms a few times per month.  Mark a 3 if you experience that symptom a few times per week.

n-1 Nutrition Questionnaire
n-2 Nutrition Questionnaire
n-3 Nutrition Questionnaire
n-4 Nutrition Questionnaire

If you are looking for a Chiropractor in Sterling Va or Chiropractor in Herndon Va or Chiropractor in Fairfax Va