SHORT NEW PATIENT HISTORY FORM - St. Louis
Constipation Muscle aches/muscle pain/muscle spasms; where: Diarrhea or loose stool forearms, fingers, thighs, legs/feet, neck Gas generalized (encircle all that apply) Belching Muscle cramps/charley horses Bloating Low back pain/spasm Abdominal pain Pain/tightness in upper back White, coated tongue Pain/tightness in neck, shoulder area ... ................
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