Contact -- SpineTrac -- the Moore Spine Center

SpineTrac

Moore Spine Center
(949) 653-6777
.

Contact Dr. Moore
at the Moore Spine Center

To better help us tailor your back treatment or for more information about the

system, please fill out this simple questionnaire, or call the Moore Spine Center at (949) 653-6777. You can also email Dr. Moore by clicking here.

Name (Required)

Phone Number (Required)

Email Address (Required)

Do your heels wear out evenly?	Yes	No
Can you take a satisfying deep breath?	Yes	No
Does your jaw click?	Yes	No
Do you have to "crack" your neck, back or other joints?	Yes	No
Can you twist or turn your head or hips to either side easily & equally?	Yes	No
Are you often fatigued?	Yes	No
Do you have poor concentration?	Yes	No
Does your foot flare out when walking?	Yes	No
Do you have low resistance to sickness?	Yes	No
Does one leg appear shorter than the other?	Yes	No
Do you have poor posture?	Yes	No
Do you have headaches, back aches, sore or tender spots in muscles or joints?	Yes	No
Do you feel stiffness in your back or neck?	Yes	No
Do you feel just like you're not right, and your health should be better?	Yes	No
Do you have a constant stressful feeling and tension in muscles and joints?	Yes	No

Questions:

Email Dr. Moore

Moore Spine Center
Dr. Robert Moore, D.C.

4950 Barranca Parkway, Suite 103
Irvine, California 92604
(949) 653-6777 ~~~ fax: (949) 653-9951