This questionnaire is a supplementary form and should be filled out upon doctor or health coach request to help ascertain possible stressors in your life.
Some questions may seem sensitive to you, but, by law, all of the information you give us is protected and only Dr. Paul Kwik and our trained Health Coaches -- when they are involved in your direct care -- will ever see the information on this form. It will not be shared with anyone else. If you still do not wish to share certain information with us, it is your right to do so, but please remember that not sharing this information limits our ability to treat you and, therefore, limits your body's ability to heal itself.
Dr. Kwik's Body Intelligent Center
Dr. Paul is a Chiropractor and has enjoyed an active practice in Orange County, California since 1993 and he is grateful to have helped many people throughout Orange and Los Angeles counties obtain the relief and health they desire. He has a family practice ranging from newborns to the elderly; treating a variety of symptoms ranging from runny noses, digestive disturbances and endocrine imbalances as well as migraine headaches, neck/low back and extremity pain.
Dr Kwik specializes in Gentle, Non force Chiropractic care (Active Release Technique and Acupressure for Pain and Stress Reduction) and Specific Bio Electric Reflex testing (Nutritional Reflex Assessment) to analyze the body’s nutritional and structural imbalances so that the root cause of a problem can be identified. Many come to Dr. Paul after treatments with other practitioners have failed.
