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Better Results Faster Questionnaire
Live Well Chiropractic
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Name
*
Your answer
Your brain communicates with your body by sending and receiving message through your ____________________?
Your answer
What is the most important system in the body for staying healthy?
Digestive System
Cardiovascular System
Nervous System
Immune System
Clear selection
There are _____ stages of Chiropractic care?
1
2
3
4
Clear selection
I am in the _________________ stage of care?
Initial Intensive Care
Corrective Care
Wellness Care
Clear selection
In order for my body to heal optimally and reach my goals my recommended schedule of care is?
1 time per week
2 times per week
3 times per week
1 time per month
Clear selection
The four legs of the stool of results are?
Your answer
How do you know if you have subluxations?
Your answer
What do you have to do to correct health problems
Keep doing the same things
Take action
Do Nothing
Rely on others do do something for me
Clear selection
What action steps are you starting from the bad habits sheet?
Your answer
Is there anyone you know who should have their nervous system checked for subluxation? If so, who?
Your answer
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