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Day-After Check-In

How are you feeling today, one day after your treatment? This is a quick 2-minute check on your comfort and how your body is responding. It helps us make sure everything is on track.

Your Wellbeing

How would you rate your physical health?

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How would you rate your physical health?

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How would you rate your mental & emotional health?

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How would you rate your mental & emotional health?

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How well can you do your usual activities (work, home, leisure)?

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How well can you do your usual activities (work, home, leisure)?

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How would you rate your sleep quality lately?

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How would you rate your sleep quality lately?

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How would you rate your energy levels lately?

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How would you rate your energy levels lately?

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How would you rate your mood and stress resilience?

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How would you rate your mood and stress resilience?

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How would you rate your ability to concentrate and focus?

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How would you rate your ability to concentrate and focus?

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Overall, how well have you been feeling lately?

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Overall, how well have you been feeling lately?

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Your Pain

How much pain are you in right now?

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How much pain are you in right now?

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At its worst this past week, how bad was the pain?

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At its worst this past week, how bad was the pain?

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At its best this past week, how bad was the pain?

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At its best this past week, how bad was the pain?

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How much has pain interfered with your daily life this week?

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How much has pain interfered with your daily life this week?

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Your Medication

Are you currently taking pain medication for your condition?

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Are you currently taking pain medication for your condition?

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None

Are you currently taking pain medication for your condition?

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Occasionally

Are you currently taking pain medication for your condition?

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Daily (over the counter)

Are you currently taking pain medication for your condition?

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Daily (prescription)

Your Safety

Since your treatment, how concerned are you about any new or worsening symptoms?

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Since your treatment, how concerned are you about any new or worsening symptoms?

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Anything you'd like us to know? (optional)

Your Spine

Please answer about your back and/or neck — the area or areas we treated. If more than one part of your spine was treated, rate things overall.

How much does your spine pain limit sitting?

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How much does your spine pain limit sitting?

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How much does your spine pain limit standing?

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How much does your spine pain limit standing?

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How much does your spine pain limit walking?

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How much does your spine pain limit walking?

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How much does your spine pain limit lifting or carrying?

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How much does your spine pain limit lifting or carrying?

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Do you have pain, numbness or tingling travelling into your arms or legs?

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Do you have pain, numbness or tingling travelling into your arms or legs?

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Your Joints

Please answer about the joint or joints we treated. If we treated more than one, rate them as a whole — overall, how they feel.

Overall, how stiff do your treated joints feel?

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Overall, how stiff do your treated joints feel?

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Overall, how much swelling is there?

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Overall, how much swelling is there?

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How freely can you move them — bending, straightening, raising?

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How freely can you move them — bending, straightening, raising?

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Do any of them feel unstable, weak, or give way?

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Do any of them feel unstable, weak, or give way?

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Your Vitality

How would you rate your energy levels?

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How would you rate your energy levels?

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How would you rate your physical recovery?

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How would you rate your physical recovery?

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How would you rate your physical strength?

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How would you rate your physical strength?

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How would you rate your endurance / stamina?

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How would you rate your endurance / stamina?

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How would you rate your flexibility / mobility?

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How would you rate your flexibility / mobility?

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How would you rate your sleep quality lately?

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How would you rate your sleep quality lately?

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How would you rate your motivation and drive?

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How would you rate your motivation and drive?

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How would you rate your mood and stress resilience?

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How would you rate your mood and stress resilience?

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How would you rate your ability to concentrate and focus?

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How would you rate your ability to concentrate and focus?

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Overall, how well have you been feeling lately?

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Overall, how well have you been feeling lately?

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