Kinesiolgy Specialists
Kinesiolgy Specialists

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 CONTACT DR. DAVE

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Personal Information
Name
Date of Birth
Address
City
State
Zip Code
Phone Number
Email Address
Occupation
Which school do you work for?
Health History
Do you have any of the following? (check all that apply) High blood pressure Diabetes High cholesterol
Cancer Heart disease COPD
Edema Osteopenia Osteoporosis
Persistent headaches Back problems Neck problems
Shoulder problems Elbow problems Wrist/hand problems
Hip problems Knee problems Ankle/foot problems
List all surgeries and dates
List all medications
What are your health goals?
Comments
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