Nervous System Form

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Sample of Completed Nerve FormYour Nervous System Controls Everything

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

It's one of the most powerful patient referral resource we offer.

"I can hardly wait to show this to..."

The idea that the nerve supply to various organs and tissues are supplied at different segmental levels is astonishing to most patients.

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

At your report, circle the problem areas you found. Help patients grasp the potential neurological impact of their spinal problem.

How Chiropractic Care Influences Whole-Body Health

Since this nerve function patient handout is a posterior view, it demonstrates 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
Pkgs of 50 forms
8½" X 11"
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