Progress Evaluation 1

Name
3. How would you rate your improvement?
5. How would you rate the service in our office?
7. Why are you here?
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1. Below you will find your initial pain rating on a scale of 0 to 10 with 10 being the worst pain and zero being no pain. In the current rating column please rate the pain that you are currently experiencing. Under frequency and improvements, please check all boxes that apply.

Other
Other
Other
Does anything you do aggravate your condition(s):
Does anything relieve your discomfort?

When you first began care at this office, you indicated a limiting ability to perform the highlighted daily activities; please identify how your current condition is affecting your ability to carry out these activities.

Essential 1: Maximized Mind

Are you sleeping better since starting care?
Are you handling pressure and deadlines more easily since starting care?

Essential 2: Maximized Nerve Supply

Have you missed any appointments?

Essential 3: Maximized Quality Nutrition

Do you eat breakfast daily?
Do you regularly drink (1 or more per day) any of the following? (Check all that apply)

Essential 4: Maximized Oxygen and Lean Muscle

Essential 5: Minimized Toxins

Have you or any members of your family had a vaccination or flu shots since starting care?
Have you been able to reduce any medications since starting care?
Are you taking any new medications since starting care?
Do you need more information on the usefulness and the side-effects of drugs, vaccines, and other medical treatments?
Have you started any of the following programs to support your body’s ability to heal?
Do you have any questions or need help with any of these programs?
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Get Started on Your Wellness Transformation

Align your health naturally with one or a combination of these chiropractic essentials. We provide customized chiropractic services to help you find your unique path to transformation. Get started transforming your health today with Good Life Family.
Contact Details
Good Life Family Chiropractic
Address:
7011 Kentwell Lane #200
Lincoln, NE 68516
Tel: +1 402 413 8825
Email: frontdesk @goodlifefamilychiropractic.com
Office Hours
Monday:8:00 am – 10:15 am
3:00 pm – 6:00 pm
Tuesday:3:00 pm- 5:10 pm
Wednesday:8:00 am – 10:15 am
3:00 pm – 6:00 pm
Thursday:3:00 pm – 6:00 pm
Friday:8:00 am – 10:15 am
Saturday:9:00 am – 10:15 am
Sunday:Closed
© 2021 Danny Veiga, Good Life Family Chiropractic. 
                    All Rights Reserved.
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