Dis-Ease to Ease, Pain to Power, Working Wellness

With Dr Rich Oberleitner

Manual Medicine

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Symptoms: where is your pain

What brings you here

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Phone:

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Weight Loss Program Item One Item Two Item Three

Headaches

Neck Pain

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Quick Fix Adjustment

Medical Referral Exam

Aerobic Exercise 3+ days a week

Joint Mobilization

Trigger Point Therapy

Deep Tissue Massage

Massage

Vitality

Cardio Vascular Rehab

Low Back Pain

Leg Pain

Arm Pain

Injury Specific Massage

Activator

Allergies Item One Item Two Item Three

Stress Relief

Hand Pain

Overweight

Drink Soda/ Coffee Daily

Massage school inquiry

Full Exam: Medical Referral

Therapeutic Massage

Cardiovascular Challenges

High Blood Pressure

Traditional Adjustment

Natural Health

Ergonomics

Personal Training

Foot Pain

Strength Training 3+ days a week

Non-force Adjustment

Drop Table

Your needs / Health Coaching

Date of Birth

Check only what applies to  you

Your favorite past treatment / Preferred Techniques

Services Requested

Lifestyle Survey

Diabetic

Drink water

Salads/ Fruits 2+ Serving a day

Problems sleeping

Depression

Nap / Meditate

Unrefined carbs 1+ serving a day

Stress

Stretch / Yoga 3+ a week

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