McTimoney Chiropractic for Everybody Please answer the following questions, and you will receive a FREE online assessment, as to whether McTimoney Chiropractic could help you feel healthier. * indicates required fields    *Do you suffer with any of these?:  Low/Mid back pain  Sciatica  Neck pain/Stiffness  Headaches/Muzzy heads  Migraines  Feeling "out of balance"/spaced out  Joint pain ie Knee, elbow etc  Numbness anywhere on the body  Pins and Needles/Tingling  None of the above   Have you discussed this with your GP?:  Yes  No   Have you seen a Complementary Therapist?:  Yes  No   Who?:  Chiropractor  Osteopath  Massage Therapist  Bowen  Acupuncture  Homeopath  Herbalist/Naturopath   Other?:   Was it successful?:   Do you have any of the following?:  Osteo-arthritis  Osteoporosis  Rheumatism  Joint replacements  Fibro-myalgia  Cancer   Are you receiving any medical treatment for it?:  Yes  No   Briefly describe:   *Do you have one leg longer than the other?:  Yes  No  Not as far as I am aware   *Have you ever been in an accident?:  Car/Motorbike accident  Fall down stairs  Broken bones  Skiing/Skating  Other  None that I am aware   Have you ever had a "slipped disc":  Yes  No   Have you ever had spinal surgery?:  Yes  No   Do you have any of these?:  Lack of Energy  Lethargy  Sleep disturbances  Depression associated with pain  Feeling unable to "cope"  Restlessness   Anything else that you should make us aware of?:   *Name:   *Email:   *Town/Postcode: Please hit "submit" to send your answers for analysis, to see if McTimoney can help you achieve optimal health.

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