Rev Chiro Application Form
How do you identify your gender?
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How do you identify your gender?
Have you had chiropractic care before? If so, what type?
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Are you currently experiencing a condition or discomfort you believe chiropractic care could address? Please describe
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How long has this condition or discomfort affected you?
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Have you consulted any healthcare professional regarding your condition? What was advised? What have you tried?
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Have you ever discontinued a treatment or therapy before completion? If yes, could you share why?
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Corrective Chiropractic Care, especially corrective treatments, are a commitment both time-wise and financially. Have you considered how to accommodate this into your budget?
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Corrective Chiropractic Care, especially corrective treatments, are a commitment both time-wise and financially. Have you considered how to accommodate this into your budget?
Why are you considering chiropractic care at this time?
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Is there anything you would like us to know about your health and wellness goals?
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