Patient Forms
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Chris Wilkerson, DC offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
New Patient Health History Form - Required When coming to our office, the more we know about your medical condition, the better we can provide care. This questionnaire will help you give us the most complete information. You will be asked for your PRIMARY REASON FOR THE VISIT, and then questioned about your CURRENT SYMPTOMS and MEDICAL HISTORY. Print the New Patient pdf form, fill them out and take them to our office on your first visit. Thanks for your patience. You are also welcome to email them in advance. Send email to digitaldocsusie@sbcglobal.net. Thanks in advance. This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know! Download the Free AdobeReader® |
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Neck/Back Bournemouth Questionnaire
Briefly, an outcome assessment is defined as "a form of measurement of progress toward a specific goal." The many and varied types of evaluations that are done to assess the outcomes of chiropractic rehabilitation fall into two general areas: subjective and objective determinations. Both can be very helpful in evaluating progress; they provide an insight into two different components of the healing process. The Bournemouth Questionnaire is a comprehensive outcome measure for back pain. The instrument has established validity, consistency and reliability, and demonstrated responsiveness to clinical change. It is practical for both the efficacy and effectiveness of back pain treatments. It measures the following seven back pain model traits: pain intensity, daily activities, recreational/social/family activities, anxiousness, depression, work activities and pain control.
A score of zero to 10 is possible for each of the seven categories, which provides a total possible score of 70, where 70 represents the highest disability score possible and zero represents the best spinal health score.
Briefly, an outcome assessment is defined as "a form of measurement of progress toward a specific goal." The many and varied types of evaluations that are done to assess the outcomes of chiropractic rehabilitation fall into two general areas: subjective and objective determinations. Both can be very helpful in evaluating progress; they provide an insight into two different components of the healing process. The Bournemouth Questionnaire is a comprehensive outcome measure for back pain. The instrument has established validity, consistency and reliability, and demonstrated responsiveness to clinical change. It is practical for both the efficacy and effectiveness of back pain treatments. It measures the following seven back pain model traits: pain intensity, daily activities, recreational/social/family activities, anxiousness, depression, work activities and pain control.
A score of zero to 10 is possible for each of the seven categories, which provides a total possible score of 70, where 70 represents the highest disability score possible and zero represents the best spinal health score.