CLA PreScan Checklist

of 50 forms
Buy in bulk and save

Are patients unknowingly corrupting your sEMG scans? Find out! Uncover patient activities that affect the accuracy and value of your sEMG and thermal scans with this critical intake form.

Dr. David Fletcher CLA

Use the PreScan Checklist to identify things that could distort the precision of your scans. Meanwhile, patients get a quick education about things that negatively influence the nervous system.

  • Your new patient reveals they regularly drink three cups of coffee a day. Should you scan them anyway? (Probably, especially if this is "normal" for their nervous system.)

  • A new patient's initial scan shows no pattern of subluxation! How come? (Their PreScan Checklist reveals they took an antihistamine prior to their appointment with you.)

  • A patient appears to be getting great results. But their progress scan is lit up like a Christmas tree. How come? (Their PreScan Checklist reveals that prior to their scan they came from a workout at the gym.)

Bring greater accuracy to your scanning protocol with the PreScan Checklist. Add it to your new patient paperwork package and avoid unexplained scans in the process. Check out our other supplies designed for Chiropractic Leadership Alliance chiropractors.

Works great with MyoVision technology too!

CLA PreScan Checklistimplementation-ideas.gif
Pkgs of 50
8 1/2" X 11"

UK flag International Orders

239 Words
7.8 Grade reading level

Your nervous system controls and regulates every cell of your body. We use an instrument that reveals how well your nervous system is working.

Please let us know if we need to be mindful of the following:

Drinking coffee or tea can excite the nervous system. Have you had any of these caffeinated beverages today?
❏ No ❏ Yes About _____ cups.

Cola drinks contain caffeine and chemicals that can affect the nervous system. How many sodas have you had today: ____.

Nicotine is a nervous system stimulant. Have you used any tobacco today?
❏ No ❏ Yes How much: ____

Common, over-the-counter drugs can impact the nervous system. Have you taken any of these types of drugs today?
❏ No ❏ Yes ________________________________

Many prescription drugs and muscle relaxers affect the nervous system. Have you taken any type of prescription medication today?
❏ No ❏ Yes ________________________________

Excessive exposure to the sun affects the accuracy of your scan. Have you had a sunburn in the last five days?
❏ No ❏ Yes

Bath salts, oils or sunscreen on your skin can influence instrument sensitivity. Have you used any of these products today?
❏ No ❏ Yes

Vigorous physical activity can exaggerate your scan results. Have you had a workout today?
❏ No ❏ Yes

Stress, depression, anxiety or emotional upsets can affect nervous system tension. Compared to a typical day, are you currently experiencing an increased level of stress?
❏ No ❏ Yes

© 2004 Patient Media, Inc.