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PROGRESS EXAM
QUESTIONNAIRE #2

Our goal is to offer the highest quality care possible. It is common to notice positive changes in your overall health and well-being as your nervous system function begins to improve. Please help us by responding to the following questions about your wellness care in our office.

Please provide us with feedback on how you are doing with the following:

Overall Quality of Life
Sleeping
Mood/Thinkin/Concentration
Diet/Nutrition
Energy Level
Ability to Move
Ability to perform usual household activities
Ability to perform recreational activities (sports/hobbies)
If you had a specific complaint, has there been any overall change with tha condition?
What is better to base your health on?
Is there anything in your life causing reoccurring stress?
Have you recently had any falls or prolonged postures? (ie driving, sitting)
Do you need help with nutritional changes?
Do you need help with stress management?
Are you exercising regularly?

Thanks for submitting! We have received it.

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