SHARE YOUR

JOURNEY

We love learning how individualized chiropractic care is changing your body, your health, and your life. It is why we do what we do, and we are encouraged whenever we hear these stories. You can help ignite a passion for true health, movement, and resiliency in our community by sharing your own personal journey!

All you need to do is write in your own words your chiropractic journey. Use the instructions and questions provided as a guide. Once you have submitted this form, we will utilize a photo or video of you from our treatment time (if you are okay with that). Thank you for sharing your story! I appreciate it and your dedication to optimal health and performance!

Name

First Name

Last Name

When did you start care at Resilience Chiropractic?

Tell us about your first impressions of Resilience Chiropractic and Dr. Payton. What were you surprised or impressed by?

Did you have any concerns with chiropractic, reasons you had not tried chiropractic before, or previous underwhelming treatment outcomes? How has that changed?

Describe the health conditions you were experiencing when you started care at Resilience 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 Resilience Chiropractic?

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

Have you eliminated any medications? Has your mood, energy, or activity levels 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 Resilience Chiropractic to a friend or family member, what would you say?

Please add any additional comments about your experience at Resilience 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 Resilience Chiropractic, or anyone authorized by Resilience 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 Resilience 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).

Date

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SHARE YOUR

JOURNEY

Thank you for joining the Resilience community!

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