Pre-consult

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Patient name

Parents (if child)

Date of birth

Age

Gender

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Female

Address

Suburb

Zip / Postcode

Home telephone

Work telephone

Mobile telephone *

Occupation (what takes up most of your time)

How did you find out about us?

Who referred you?

Please list all your current medications

Please list all your previous surgeries or hospitalisations

Please list any condition or illness you have previously been diagnosed with

Please tell us the name of your GP and their address

Please tell us about your family medical history, do you know of any conditions they have?

What is the main reason for your visit today?

When did this start? (how long have you had it)

Please tell us where your pain / problem is located

If you have pain, does your pain travel or refer to another area? Or does it stay in the one spot?

If it does travel, where does it go? (eg down the arm to the middle finger)

Have you had this pain or similar pain before? When?

What makes this pain worse? Please list

What makes this pain better? Please list

Are you taking medications for it? And have these worked?

Is your pain getting worse?

Has it stopped you from doing anything? (eg sitting or running)

Have you seen anyone else (other treatment) for this condition?

Book an appointment today

Sydney Spine & Sports Centre (S3C) is a chiropractic centre located in Balmain and Rozelle Sydney. You are what matters most and you are our priority. We offer evidence-based chiropractic treatments for all spine, sports muscle and joint injuries. Our chiropractors offer one-on-one appointments that are unrushed and conducted in a friendly environment. We are invested in getting you better and doing all we can to get you out of pain and back to your pre-injury life. At Sydney Spine & Sports Centre (S3C) we help fix your pain and offer you solutions on how to improve your function. Visit one of our Balmain or Rozelle clinics today for safe, effective and ethical treatments delivered by a chiropractor that is passionate about getting you better.

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Pre-consult

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Balmain Clinic

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