SHARE YOUR STORY

We love learning how principled chiropractic care is changing your body, your health, and your life. It is why we do what we do, and our team and practice members are encouraged whenever they hear these stories. You can help ignite a passion for true health and healing in our community by sharing your own personal health story!

All you need to do is write in your own words your chiropractic story. Use the instructions and questions provided as a guide. Once you have submitted this form, we will take and attach a photo of you (if you are okay with that). Thank you for sharing your story! We appreciate it and your dedication to chiropractic!

Name

First Name

Last Name

When did you start care at Mission Chiropractic?

Tell us about your first impressions of Mission Chiropractic, Dr. Haley and the Mission Team? What were you surprised or impressed by?

Did you have any concerns with chiropractic, or reasons you had not tried chiropractic before? How were those fears put to rest?

Describe the health conditions you were experiencing when you started care at Mission Chiropractic. How did those health conditions impact your day to day life?

How long have you been dealing with these health concerns, and had you tried any other medications or treatment options prior to coming to Mission Chiropractic?

How has your health improved since starting chiropractic care? How have your symptoms decreased?

Have you eliminated any medications? Has your sleep, energy, or immunity increased?

How has life changed for you now that you are under chiropractic care? Are there any activities you can now participate in, or any day to day tasks that are now easier?

If you were to recommend Mission Chiropractic to a friend or family member, what would you say?

Please add any additional comments about your experience at Mission Chiropractic, or benefits you have seen under chiropractic care that you would like others to know about:

Photography | Video | Privacy Notice

For valuable consideration, I hereby irrevocably consent to and authorize the use and reproduction by Mission Chiropractic, or anyone authorized by Mission Chiropractic, of any and all photographs/videos which you have this day taken of me, for the purpose of promotional TV and/or print ad whatsoever, without further compensation to me. All negatives and positives, together with the prints shall constitute the property of Mission Chiropractic, solely and completely. Any information voluntarily provided by a patient shall also be used in conjunction with the above listed information for purposes previously mentioned. Confidentially, in regards to any reported conditions, is also waived to the extent of the information pertinent to the promotion material only. All other unrelated patient information shall remain private and protected (according to the Health Information and Privacy Act laws). Your printed name below represents your signature of consent for Mission Chiropractic to take and utilize photos and videos as stated above.

Date

YYYY

SHARE YOUR STORY

CONTACT

HOURS

FOLLOW