Spinal Decay Patient Form

Use this chiropractic X-ray report form to "phase place" each patient, having them compare their X-rays with the examples printed here. It's a powerful way to send patients home with examples of their X-rays.

Give Your X-ray Report Greater Impact

Help them recreate your explanations to a spouse who wasn't there.

"When you compare the side view we took of your neck, with the examples printed here, which one comes closest to matching yours?"

Involve the patient and set the stage for your radiographic explanations. With a red pen, check the boxes that describe the views you’ve taken. Circle the examples that most closely match theirs. Identify the bone spurs, disc narrowing or loss of curve that match the patient’s X-rays.

It might look something like this image to the right when completed.

Match Your X-ray Technique

Choose left- or right-facing (as shown above) to match your X-ray technique. The Spinal Decay phase degeneration sheet coordinates with our Spinal Decay chart. Position it next to your viewbox.

Still using the term subluxation degeneration that patients associate with the aging process? Time to simplify!

Spinal Decay X-ray Report of Findings Form
Pkgs of 50 patient handouts
Indicate Left- or Right-Facing
8½" X 11"
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