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Chiropractic / Spinal decompression / Spinal adjustment / Sciatica / Pain / Medicine / Health / Alternative medicine


East Valley Spinal Decompression Center, L.L.CE. Baseline Rd., Ste.101 Gilbert, AZ1068 FaxPatient Registration and History Questionnaire Name:
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Document Date: 2011-02-15 19:01:40

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Company

East Valley Spinal Decompression Center L.L.C. / YOUR GROUP HEALTH INSURANCE COMPANY / /

Facility

Date Facility / /

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IndustryTerm

healthcare / /

MedicalCondition

Acute onset urinary retention / numbness / allergies / injury / ache / burn / cancer / progressive muscle weakness / osteoporosis / AIDS / irritation / infection / illness / MS / stroke / muscle spasms / fecal incontinence / injuries / Tuberculosis / /

MedicalTreatment

self management / chiropractic adjustment / Immunosuppression / organ transplant / surgery / chiropractic manipulation / /

Person

Complaint / /

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Technology

Ultrasound / Laser / /

SocialTag