Where Healing Happens- You Don't Have to Live with Pain

[et_pb_section bb_built=”1″ admin_label=”section”][et_pb_row admin_label=”row” background_position=”top_left” background_repeat=”repeat” background_size=”initial” _builder_version=”3.0.105″][et_pb_column type=”4_4″][et_pb_text background_layout=”light” use_border_color=”off” background_position=”top_left” background_repeat=”repeat” background_size=”initial” _builder_version=”3.0.105″]

[three_fourth]Here are convenient links to the forms needed for your first visit to Action Medical and Chiropractic. Please print and fill out.


Chiropractic and Medical New Patient Forms


Physical Therapy Only –  TriCare


Weight Maintenance/Loss- New Patient Forms 


When completing your forms we want to stress that DETAIL IS IMPORTANT!

Think about these questions as you fill out your forms:

1. WHEN did it begin?
Insurance companies want the exact date of injuries, accidents or falls. For slowly developing problems think back, was it really weeks or has it been months. Is this the very first episode, or have you ever had something similar?

Is the pain in the center? Worse on one side? Use the form to mark all trouble areas.

3. Is there a problem in only one specific place or does it radiate?
Does it go up, into the head and cause headaches sometimes?
Down? Into the leg, if so past the knee? Which fingers, which toes, what part of the foot or hand?

4. What does it feel like? Tight like a tight muscle? Sore? Sharp when you turn?

5. Grade the pain.
Our 0-10 scale helps us understand what only you can feel.  People regard their pain differently so here are some guidelines:

  • 0 (zero) is NO pain,
  • 3 – Pain would be present, but as you get busy you forget about it, but if you think about it, you notice it’s there.
  • 5 – Can’t forget about it, but you are able to do you normal activities
  • 8 – High degree of discomfort, must modify your activity due to the pain
  • 10 – Is awful, horrible unbearable, normal activity impossible.

6. WHEN do you feel the pain?
Is it worse in the morning, only present in the evening, does it keep you from sleeping? Everyday? Worse on workdays? Is it related to any specific activity or stress? What if anything makes it better or worse? (most of us are so busy trying to work around discomfort we have to think about this one in order to answer)

Is there anything that the forms don’t tell us? It is not uncommon to find a 65-year-old grandmother is raising a 2-year-old and has to lift a 35-pound child 10 times a day. A truck driver may not just drive but also unload a full vehicle with a handtruck daily.


[/et_pb_text][et_pb_code admin_label=”Analytics Code” global_module=”1914″ saved_tabs=”all” background_position=”top_left” background_repeat=”repeat” background_size=”initial” disabled=”off” disabled_on=”off|off|off” _builder_version=”3.0.105″]<script async src=”https://i.simpli.fi/dpx.js?cid=77530&action=100&segment=Retargeting&m=1&sifi_tuid=44738″></script> <script> (function(i,s,o,g,r,a,m){i[‘GoogleAnalyticsObject’]=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,’script’,’https://www.google-analytics.com/analytics.js’,’ga’); ga(‘create’, ‘UA-77863504-1’, ‘auto’); ga(‘send’, ‘pageview’); </script>[/et_pb_code][et_pb_text admin_label=”Long Disclaimer” background_layout=”light” text_orientation=”left” use_border_color=”off” border_color=”#ffffff” border_style=”solid” saved_tabs=”all”]


All information contained within this site is for informational purposes only. It is not intended to diagnose, treat, cure, or prevent any health problem, nor is it intended to replace the advice of a qualified medical practitioner, health practitioner, or fitness professional. No action should be taken solely on the contents of this website. Always consult your physician or qualified health professional on any matters regarding your health or on any opinions expressed within this website. The information provided within this website is believed to be accurate based on the best judgment of the authors but the reader is responsible for consulting with their own health professional on any matters raised within. We do not assume any liability for the information contained within this website, be it direct, indirect, consequential, special, exemplary, or otherwise.


[/et_pb_text][et_pb_code admin_label=”Google Code” saved_tabs=”all” global_module=”2473″]<script type=”text/javascript”><!– [et_pb_line_break_holder] –>/* <![CDATA[ */<!– [et_pb_line_break_holder] –>var google_conversion_id = 864958474;<!– [et_pb_line_break_holder] –>var google_custom_params = window.google_tag_params;<!– [et_pb_line_break_holder] –>var google_remarketing_only = true;<!– [et_pb_line_break_holder] –>/* ]]> */<!– [et_pb_line_break_holder] –></script><!– [et_pb_line_break_holder] –><script type=”text/javascript” src=”//www.googleadservices.com/pagead/conversion.js”><!– [et_pb_line_break_holder] –></script><!– [et_pb_line_break_holder] –><noscript><!– [et_pb_line_break_holder] –><div style=”display:inline;”><!– [et_pb_line_break_holder] –><img height=”1″ width=”1″ style=”border-style:none;” alt=”” src=”//googleads.g.doubleclick.net/pagead/viewthroughconversion/864958474/?guid=ON&script=0″/><!– [et_pb_line_break_holder] –></div><!– [et_pb_line_break_holder] –></noscript><!– [et_pb_line_break_holder] –><!– [et_pb_line_break_holder] –>[/et_pb_code][/et_pb_column][/et_pb_row][/et_pb_section]