Head/Neck, MVA or Whiplash Screen

As per our discussion over the phone, prior to your appointment please complete this screening form to allow us to better establish your treatment plan before you arrive.

Please answer the following questions to the best of your knowledge

Do you have any of the following symptoms?

Rate from 0 being no symptoms to 6 being severe symptoms

If you have any questions please call us
Red Deer Main: 403-314-4458
Olds: 403-791-2766
Red Deer Campus: 403-352-7979