We can’t wait to hear your story! Name * First Name Last Name What symptoms/condition did you have when starting care? How long? how severe? What activities were limited by your Symptoms/condition? What improvements have you seen? How long did it take? Have you reduced or eliminated any medications? if so, what? How has chiropractic care changed your life? Are there things in your life you are able to do now that you weren't before starting care? DID you have any doubts that chiropractic care would help with your symptoms/condition? Have you noticed any changes that were surpising or that you thought chiropractic care wouldn't be able to help with? (ie. sleeping better, having more energy, better digestion) For valuable consideration, I consent to and authorize the use and reproduction of my above statements by Pivotal Family Chiropractic, or anyone authorized by Pivotal Family Chiropractic, of any and all photographs/videos which you have this day taken of me, for the purposed of promotional TV and/or print ad whatsoever, without further compensation to me. Any information voluntarily provided by a patient shall also be used in conjunction with the above listed information for purposes previously mentioned. All other unrelated patient information shall remain private and protected (according to Health Information and Privacy Act laws). I agree Thank you for sharing!
