Condition Treated

Please tick any of the following symptoms you have experienced at any time in the last 12 months:

  • Headaches
  • Neck pain/ stiff neck
  • Dizziness
  • Ringing in the ears
  • Numbness/Tingling in arms or hands
  • Shoulder tension/ Pain
  • Pain between shoulders
  • Breathing Problems/Asthma
  • Digestive problems
  • Reproductive problems
  • Low Back Pain
  • Hip Pain (Left or Right)in
  • Numbness/ Tingling in legs or feet
  • Difficulty Sleeping
  • Nervousness
  • Depression
  • Allergies
  • Recurrent Flu / colds
  • Weight Problems
  • Menstrual Problems
  • Tension and Irritability

Download New Patient Form

New Patient Form

Download New Patient Form (Age 0-11)

New Patient Form (Child)