Questionnaire

Questionnaire: ChiroNetwork HealthCare Center Questions

Please choose A, B, or C.

Patient Name *		Date

1. How does chiropractic work?

A. X-Rays cause the spine to adjust.

B. Herbal supplements are prescribed.

C. Chiropractic works because you are a self-healing, self-regulating organism controlled by your nervous system.

2. Do I have a slipped disc?

A. Yes

B. Possibly.

C. However, a disc can�t slip because of the way it attaches to the spinal bones above and below it. A disc can bulge. It can tear. It can herniate. It can thin. It can dry out. And it can collapse. But it can�t slip.

3. How do you get subluxations?

A. From high altitude flying.

B. Being emerged in water.

C. Physical causes could include slips and falls, accidents, repetitive motions and improper lifting.

4. What�s an adjustment?

A. Examination

B. X-Rays.

C. Chiropractic adjustments usually involve a quick thrust that helps add motion to spinal joints that aren�t moving right

5. Are chiropractic adjustments safe?

A. No.

B. Drugs, over-the-counter pain relievers and invasive surgery are probably safer.

C. Yes. A New Zealand government study found that adjustments are �remarkably safe.�

6. Will adjustments make my spine too loose?

A. Combined with an MRI, yes!

B. More than one adjustment will.

C. No. Only the spinal joints that are �locked up� receive adjustments.

7. Can I adjust myself?

A. Yes, just like the Doctor, just use a tennis ball

B. Yes, or ask a friend to help you.

C. No. Some people can make their joints �pop,� but that�s not an adjustment. Worse, damage can occur by mobilizing a joint with weakened muscles and ligaments.

8. How many adjustments will I need?

A. The number of adjustments is usually three (3).

B. No more than twenty-six (26), that�s all my insurance company will pay for.

C. The number of adjustments varies with each patient and their individual health goals.

9. Can I have chiropractic after back surgery?

A. Never.

B. Only if my surgeon advises so.

C. Yes. Rest assured that your chiropractic doctor will avoid the surgically modified areas of your spine.

10. How long until I�ll feel better?

A. Some day.

B. Usually after fifteen (15) adjustments.

C. Some patients experience almost instant relief. Others discover it can take many weeks or months.

11. How long will I need chiropractic care?

A. After twelve (12) treatments, no further care will be needed.

B. After one (1) year of care, no further care will be needed.

C. After patients get the relief they want, many choose to continue with some type of periodic care.

12. Why don�t medical practitioners and chiropractic doctors get along?

A. Because prescription drugs are really the only way to treat a biomechanical problem.

B. Because surgery is the only option that really last, and is the most effective.

C. That�s changing. Years of prejudice and bias are giving way to research showing the benefits of chiropractic care.

13. What if my policy doesn�t cover chiropractic care?

A. Then you should not do anything at all. You must live with the pain.

B. Since your insurance company doesn�t pay for something, then it must not be a benefit you should have.

C. Your health affects everything you do and everyone you know. It is your most valuable possession� Don�t allow the profit motive of a huge corporation to make the decision for you. Find out how we make chiropractic care affordable for just about anyone

14. Will I ever be normal again?

A. No.

B. Of course. Everyone will.

C. Patient results vary. Many report improved spinal curves and the total resumption of their normal lifestyle.

Thank you for taking time to complete this valuable and informative questionnaire.

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