Do I Qualify For A Free
DRS Consultation & Examination?
NORTHWEST CHIROPRACTIC CENTER
5728 Frantz Road Dublin, Ohio 43016
Phone: 614.792.3444
Fax: 614.792.2544
Goal: Helping you find health and balance in life.
To determine if you qualify, please complete the following questionnaire or call our office at 614.792.3444.
Where is your pain located?
Are you concerned that you made need surgery?
How many physicians have you had evaluate your condition? What specifically did they say was wrong?
Have you had a recent MRI performed?
If yes, when was it perfomed?
Have you ever had a surgical repair of an aortic aneurysm?
Are your legs paralyzed?
Have you ever had any bones in your neck or lower back surgically fused together?
Have you ever had a fracture in your neck or lower back?
If yes, it:
If no - if the Doctor determines that you need one, would you be open to that?
Have you ever had cancer in your neck, lower spine, or pelvis?
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Anything else you think we should know?
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Daytime Phone Number:
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