Take the Stress Test

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By completing this survey, you qualify to receive a new patient information packet.
1) Check off any of the following symptoms you have experienced in the past 6 months:
Headache/TensionFatigue/TiredPain Anywhere in BodyDigestive DisturbanceDifficulty SleepingIrritabilityLow Back PainNeck PainWrist/Hand PainElbow PainShoulder PainHip PainPain Between ShouldersKnee PainAnkle/Foot PainRinging in EarsNervousnessDizzinessAllergiesTension Across Top of ShouldersNumbness/Tingling in Arms or HandsNumbness/Tingling in Legs or FeetWeight Trouble

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.

2) Do the symptoms cause you you to be:
Difficulty Making DecisionsPoor AttitudeDecreased ProductivityExhausted at End of DayUnable to Work Long Hours

4) How does this affect your life?
Lose Patience with Spouse or ChildrenRestricts Household DutiesHinders Ability to Exercise or Participate in SportsInterferes 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 ·

We Can Help You because we gently treat your body, naturally, without drugs to remove the stress and imbalances that Cause health problems.

Would you like to get rid of the problem?
yesno

If your answer is Yes, there are alternatives available to you. Please check the item most appropriate for you.

I would like to come to Dr. Rodney Barnajian for a complete evaluation. Please call me to schedule an appointment.I would like Dr. Rodney Barnajian to me to discuss my health problems before making an appointment.I am interested in receiving more information from Dr. Rodney Barnajian

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