Nerve Form

50 tear-off sheets
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Sample of Completed Nerve FormHow You Influence Whole-Body Health

This report of findings patient form tells the real story of chiropractic—the nerve story!

Retire the disturbing 1950s graphic with all the organs spilling out. Here's a list of the major tissues connected at each segmental level. These are simple anatomical truths, uncluttered by a list of symptoms. Or a mishmash of hard-to-follow lines.

Circle the problem areas you found. Patients grasp the potential neurological impact of their spinal problem.


Since this nerve function chart is a posterior view, it shows symmetry and balance. (Indicate postural distortions and make other annotations with a red pen.)

Identify the areas where you found areas of concern. Or work from the other direction. Circle every mention of the tissue linked to their primary complaint.

Do you use surface EMG? Print the patient's scans on the backside!

Double the impact by placing the matching nervous system wall chart in your exam room.

Nerve Form Click Use Me Button for Implementation Ideas
Pads of 50 forms
8½" X 11"

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