Atlanta Chiropractor Dr. Moran specializes in auto injuries Wellness Directory Legal Matters Auto Accidents Whiplash Sports Injuries Carpal Tunnel Subluxations Leg Pain Diversified Technique Activator Method Myofascial Technique Massage Therapy Physical Therapy Flexion Distraction Arthritis Asthma Fibromyalgia Osteoporosis Orthotics Subluxations Nutrition Golf and Your Back Exercises ADHD Pregnancy Senior Fitness Sleep Stress Test Testimonials Ten Steps to Wellness         Payments Accepted:                                      United Health Care         Blue Cross         Automobile Insurance         Worker's Comp                         Attorney Liens         Major Credit Cards                Patient Financing

Stress  Test The purpose of this stress survey is to determine if any health problems you may be having are due to stress.  Please fill out this form online, then print it and bring it to the office on your first visit.  If you wish, you may first print this form, then fill it out later by hand. This form may be printed by going to the File menu at the top of this screen, then selecting Print.                                     Name                                        Age                           Home Phone                            Work Phone                                  Address                                        City                                      State                                 Zip Code                        E-mail Address                              Occupation          Hours Worked per Week               Spouse's Occupation  Hours per Week Spouse Works 1)  Please indicate how you found our clinic.:   2) Check off any of the following symptoms you have experienced in the past  six months: Headache/Tension Pain Between Shoulder Blades Fatigue/Tired Knee Pain Pain Anywhere in Body Ankle Foot Pain Digestive Disturbance Ringing in Ears Difficulty Sleeping Nervous Irritability Dizziness Low Back Pain Allergies Neck Pain Tension Across Top of Shoulders Wrist/Hand Pain Numbing/Tingling in Arms or Hands Elbow Pain Numbing/Tingling in Legs or Feet Shoulder Pain Weight Trouble Hip Pain Other  Which of the above bothers you the most?   How long have you been bothered by this condition?   Describe how it feels or affects you when it is at its worst. 3)  How does it affect you:: It makes me moody It makes me Irritable Sleep is interrupted Restricted on Daily Activities 4)  How does it affect your work: Decision Making Poor Attitude Decreased Productivity Exhausted at End of Day Unable to Work Long Hours 4)  How does it affect your life: Lose Patience with Spouse or Children Restricted Household Duties Hinders Ability to Exercise or Participate in Sports Interferes with Ability to Participate in Hobbies or other Desired Activities If you checked any of the above items, then you could be suffering from:      · Excessive Stress      · Structural Misalignment      · Pinched Nerves The doctor can help you because he gently treats your body, naturally, without drugs to remove the stress and imbalances that cause health problems. Would you like to get rid of the problem?  Yes   No

DISCLAIMER: No individuals, including those under our active care, should use the information, resources or tools contained within to self-diagnose or self-treat any health-related condition. Diagnosis and treatment of all health conditions should only be performed by your doctor of chiropractic or other licensed health care professional.

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