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自我评估备忘录用以检视是否需要接受整脊(脊椎调整)治疗
Self Evaluation Worksheet to determine whether you may be qualified for referral to the Chiropractic Health Center
1.Neck, shoulder and/or arm pain or numbness
脖子、肩膀、手臂感觉酸、麻、疼、痛。
2.Pain between shoulder blades
肩胛窝（膏肓）酸痛。
3.Low back, hip and or leg pain or numbness
腰部、臀部、腿部感觉酸、麻、疼、痛。
4.Back pain with difficulty sitting, bending and or lifting
背痛造成无法坐下、弯腰、或提举物品困难。
5.Difficulty sleeping due to neck or back pain
颈部或背部疼痛造成入睡困难。
6.Unsuccessful previous neck or back surgery, especially with recurrent or worse symptoms
以前失败的颈部或背部手术，尤其是有复发或更严重的征候出现
7.Progressive weakness in your arms/hands or legs
当你的臂膀/手或腿部感觉愈来愈虚弱无力时。
8.Transient reoccurring generalized joint pains, stiffness or swelling
间歇性全身关节疼痛,僵硬或肿胀。
9.Unable to walk more than one block due to back or leg pain.
背部或腿部疼痛以至于行走困难。
10.Inability to return to work following a work related injury
职业伤害以至于无法返回作岗位。
11.Recommended for surgery by another physician
其它医师建议实施外科手术。
12.General malaise or weakness, inability to perform activities of daily living.
感觉不舒服或虚弱而影响一般日常的生活起居。
13.Desire to have a comprehensive evaluation for establishing a general program for prevention and enhancement of good health
希望能有一种一般性的检验程序来对个人健康状况 做一个综合性的评估，以期能预防以及加强个人的健康保健
14.慢性的头痛或头昏眼花
假使您有一种或多种之上述情形时,透过本协会咨询并接受脊椎保健，将会获得很大的帮助
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