DEHEN CHIROPRACTIC SCHUGEL FAMILY CHIROPRACTIC
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1706 Lor Ray Drive
North Mankato, MN 56003
Phone: (507) 388-7744
Fax: (507) 388-8001
Email:dehenchiro@juno.com


Intake Forms

New Patients,

Please feel free to visit the link below & print the intake forms. Please complete each of them & bring them along to your initial appointment. This will expedite the initial examination process for you. 

 

Intake Forms

 

If your primary complaint is Low Back Pain, please also complete the following questionnaire.  Revised Oswestry Low Back Questionnaire 

 

If your primary complaint is Neck Pain, please also complete the following questionnaire.  Vernon-Mior Neck Pain Index 

 

If your primary complaint is Headache, please also complete the following questionnaire.  Headache Index 

 

If your primary complaint is Shoulder or Arm Pain, please also complete the following questionnaire.  DASH 

 

If your primary complaint is Leg Pain, please also complete the following questionnaire.  Lower Extremity 

 

Thanks for your help!

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