Questionnaire Questionairre Notify What is the main reason that brought you here today? Pain or discomfort Stress or tension Headache / Migraine Posture concerns Overall health and wellbeing Improved function or performance Ageing Issues / Mobility Pregnancy / Children Sleep Issues OtherHow long have you been experiencing your main concern? Less than 1 week 1 - 6 weeks 3 - 12 months More than 12 monthsWhat is your main goal? Quick relief Relief and long-term improvement Long-term wellbeing Nervous system health Understanding my health better Not sure OtherWhich area of your body is the most affected? Lower back Neck Pelvis Headaches General stiffness OtherHow would you describe your stress level? Low Moderate High OverwhelmingHow would you describe your sleep? Restful Light Poor Very disruptedHow many hours per day do you sit? 0 to 3 hours 3 to 6 hours 6 to 9 hours More than 9 hoursHave you seen a Chiropractor before? Yes NoMy Answers I understand that this questionnaire is anonymous and optional, and that my answers will be used only to guide my educational experience.View My Health Insights
