Dr. Stephanie Evans,  Founder of Integral Chiropractic  
Where East Meets West - Holistic Health Care at its Best!

DR. EVANS - A WELLNESS CENTER
NEW PATIENT INFORMATION

CALL (530)222-4745 TO SCHEDULE AN APPOINTMENT.

You may also want to request a free 10 to 15 minute phone consultation. Please specify when you speak to the office person or when you leave a message. If you leave a message, we will get back to you as promptly as possible.

PAPER WORK:
When you come to the office , there will be several forms and questionnaires to fill out and sign. Some are general , while others are specific to your condition, such as those for automobile accident cases. Bring insurance cards and information with you. You may also request that we pre-clarify your insurance coverage before you come in.

In the future will we will have our intake forms on the web site for you to download and fill out at home. Please use a medium or heavier black pen. Date the paper work when you are in the office on your first visit.

We may want to be able to consult with your family physician if needed. We may also need to get records such as previous x-rays. Having names , phone numbers and addresses will be helpful.

REGARDING MEDICATIONS AND SUPPLEMENTS:
A complete list including dosage milligrams, time of day, expected duration of Prescription etc. would also be helpful.

CAUTION: IF YOU RECOGNIZE YOUR CONDITION AS TRAUMA RELATED , WHETHER PHYSICAL OR OTHERWISE, PLEASE TAKE YOUR TIME LOOKING THROUGH THIS MATERIAL!

E.G.. AUTO ACCIDENTS CAN HAVE FAR REACHING EFFECTS.

E.G.. VARIOUS TYPES OF TRAUMAS CAN LEAVE THE BODY MIND AND SPIRIT WITH A WIDE VARIETY OF PROBLEMS .

IF YOU RECOGNIZE THE ABOVE SCENARIO FITTING YOU , YOU MAY WANT TO GO TO ONE OR MORE OF THE FOLLOOWING WEB PAGES FOR MORE INFORMATION:

www.traumasolutions.com - Diane Poole Heller PhD. has written an excellent self help book for auto accident survivors which can be used for other traumas.

www.traumahealing.com - Peter Levine PhD. is the developer of Somatic experiencing. My web page will have more on the system later.

Please refer to an article by Babette Rothschild, MSW, LCSW, "Applying the Brakes" on her website and click on Publications.

Auto Accident Recovery - For more information and a downloadable guide for what to do in case of an auto accident.

The following is a list of questions you are likely to be asked when Dr. Evans takes an oral history:

On our intake forms, there will be a list of various possible symptoms for you to choose from, but you may choose to list your symptoms in advance of your visit by printing neatly in black on an 8-1/2 by 11 inch sheet of white paper (the size of your typical computer paper) or printing something on your computer. Our office list starts with areas of the body that might have pain. It starts at the head and goes down to the feet. We also ask about thing like digestion , depression fatigue and sleep patterns. YOU MAY WANT to FOLLOW THE SAME PATTERN.

PLEASE NOTE OR BE PREPARED TO TELL THE DOCTOR IF YOU HAVE ANY SPECIFIC CONDITION THAT ANOTHER CHIROPRACTOR OR OTHER DOCTOR HAS DIAGNOSED.

The Doctor will look at your list of symptoms. She will ask you if you have any other conditions which you consider unrelated or which you don't considerer to be a problem because you are taking medication to control the symptoms. The answers to these questions help her get a well rounded picture of your situation and may help you make some connections regarding various events and symptoms.

LOCATION
1. Which symptom/problem do you find the most difficult to deal with. (This could be because of pain or because it limits your life style ). If this is a physical pain or problem we will note a location.

ONSET
2. When did this problem/symptom begin? Sometimes the condition has been going on for a long time , in which case there might be a Long term i.e. CHRONIC ONSET and an ACUTE ONSET (time that it recently started to bother you again.) PLEASE NOTE: sometimes a pain can feel like the same old pain you had last year, but in fact it is from another condition. The doctors job is to help you understand this and get to the present cause whether is it is the same old thing or something new aggravation the old problem or causing similar feelings.

INTENSITY
3. On a scale of zero to ten, with zero being nothing and ten being the worst, could you tell me the number you would give to this problem when it has been at its worst. I.E.G... If there is neck pain when it was it's most painful since the beginning of your problem, what is the highest number on the zero to ten scale that you would give to this pain.

4. Regarding your pain and difficulty in dealing with your problem in the last few weeks, what is the maximum number on the zero to ten scale you would assign?

5. Can you assign a number on the zero to ten scale for how you are feeling regarding this problem right now?

E.g.. If there is neck pain, do you feel it just sitting there or does it happen when you move?

FREQUENCY
6. How often do you get this problem? e.g. daily, weekly , monthly, constant, (including difficulty sleeping or turning in bed) several times a day, daily but only really bad one or two times a week. THERAPIES PREVIOUSLY ATTEMPTED OR IN PROGRESS.... FOR BETTER OR WORSE
7. What kinds of things have you tried to help your condition, e.g., home remedies, doctor's prescriptions, exercise programs, over the counter medications, nutritional programs.

8. What has worked the best?

9. Has there been anything that you've tried that has made you feel worse?

PERSONAL ASSESSMENT REGARDING OUTCOME OF THIS TREATMENT PROTOCOL
10. How do you feel about your condition regarding your recovery? E.g. Very optimistic , I 've heard good reports from other patients. Not very hopefull , but I figure it's worth a try.

The above questions are to give you an idea of how a history might go. Some conditions work better than others for this format. I like to think that I am always open to explore in a way that feels most comfortable to the person I'm interviewing. If the above questions fit for your condition , feel free to write or type your answers and bring them in.

The questions may be asked regarding each of you separate conditions or we may focus on one or two for the 1st session.

PHONE CONSULTATIONS
If you are going to have a phone consultation and your weight is a problem, we would like you to advise us of your height and weight. At the office, we have a scale which can calculate your body/fat ratio, based upon your height (which is input into the scale) and your weight. We will also want your age and birth date.

If it is other than a 10 minute initial consultation , you will need to clarify your form of payment in advance.

I hope that the above information is helpful.

Sincerely,

Dr Stephanie Evans (DC and RPP)