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PROGRESS EXAM
QUESTIONNAIRE #4

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 indicate which areas below you have noticed improvement in:
For adult female patients:
For adult male patients:
For children:

Thanks for submitting! We have received it.

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