By completing this survey, you qualify to receive a new patient information packet
1) Check off any of the following symptoms you have experienced in the past 6 months:
Which of the above bothers you the most?
How long have you been bothered by this condition?
Describe how it feels or affects you when it is at its worst.
2) Does this cause you to be:
3) Does this affect your work:
4) Does this affect your life:
If you checked any of the above items, then you could be suffering from:
· Excessive Stress ·
We Can Help You because we gently treat your body, naturally, without drugs to remove the stress and imbalances that Cause health problems.
Would you like to get rid of the problem? Yes , there are alternatives available to you. Please check the item most appropriate for you.
