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WIN an ipad mini! Please fill out the following questions as honestly as you can - it will only take about 3 minutes for you to be entered into our ipad mini draw!
Please enter your date of birth (so we can verify that you have been a patient of the clinic as only patients can enter)
*
DD
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Jan
Feb
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YYYY
Where was your problem? (select the one that best describes your area of complaint)
*
If you select 'other' please put an answer in the box next to it
Low back only
Low back/Sciatica
Hip
Knee
Ankle/foot
Mid back/ribcage
Neck
Headaches
Shoulder
Elbow
Wrist/hand
Other:
Which Chiropractor did you see?
*
Ian Reed
Richard Nelson
Are you now?
*
If you select 'other' please put an answer in the box next to it
Better - back to your normal self
Improved - but not back to your normal self
The same (i.e. you had no improvement)
Got worse
Receiving treatment elsewhere (e.g. hospital, GP, another clinic)
Other:
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