First Choice Chiropractic
My pain goes into my( ) Right Arm( ) Left Arm( ) Both. I have tingling and/or numbness in my ( ) Right Arm( ) Left Arm( ) Both. My pain is worse when I . Cough or Sneeze( ) Yes( ) No. Bend forward( ) Yes( ) No. Lift( ) Yes( ) No. Push( ) Yes( ) No. Pull( ) Yes( ) No. Turn my head( ) Yes( ) No. ................
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