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This Survey Could Change Your Quality of Life

Complete This Survey to See if You Are a Candidate for Chiropractic Care

Please complete the questionnaire below. To see if you qualify by phone, please call our office at 931-591-7551
Candidate for Chiropractic Care
Please check any of the primary pain complaints you are experiencing
Have you already contacted a doctor about your pain?
Have you had back surgery?
Are you scheduled for back surgery?
Have you been diagnosed with any of these conditions?
When does your condition and pain affect your activities?
If there was a way to relieve your pain with one of our advanced, non-surgical treatment programs, are you interested in scheduling an appointment with our doctors?
What are the best times to contact you?