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Lifestyle Spinal Stressor Load Tool

Is Chiropractic right for you?

Calculate Your BMI For Adults

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BMI SCORE:

ie. Your weight (179 pounds) is in the Normal category for adults of your height (5 feet, 11 inches).

1) On average, over the past 30 days, I have supplemented with a MINIMUM of 1000 IUs of VITAMIN D3 per 18 kilograms/40 pounds of body weight the following number of DAYS per WEEK:

2) On average, over the past 30 days, I have supplemented with a MINIMUM of 450 milligrams of EPA and 300 milligrams of DHA per 18 kilograms/40 pounds of body weight from an OMEGA-3 FISH OIL like COD LIVER OIL the following number of DAYS per WEEK (If you don’t supplement with Omega-3 at all, indicate your score as 0):

3) On average, over the past 30 days, I have performed at least 30 minutes of AEROBIC exercise (e.g. brisk walking, hiking, biking, jogging, swimming, etc.) the following number of DAYS per week:*

4) On average, over the past 30 days, I have performed SPINAL CONDITIONING exercises (exercises to strengthen spinal postural muscles) and SPINAL HYGIENE exercises (exercises to improve range of motion and posture ie. Y, T, L, M exercise the following number of DAYS per WEEK.*

5) On average, over the past 30 days, I have performed RESISTANCE exercise sessions the following number of DAYS per WEEK:*

0
1
2
3+

6) On average, over the past 30 days, I typically SIT at work/school, commuting, and during my leisure time for the following number of combined HOURS per DAY (only count the hour if you do NOT get up and take a spinal mobility break in that hour):*

7) During my lifetime, I have suffered the following number of SIGNIFICANT SPINAL TRAUMAS or INJURIES (from falls, accidents, work or sport activities, etc.) that have resulted in neck or back pain, and/or the need to limit activities for more than one week and for which I did not receive at least 12 visits of acute chiropractic care in the the last 6 weeks following the injury/trauma:*

8) I have had a CHIROPRACTIC SPINAL HEALTH EXAM within the past 12 months.*

True
False

9) I have had regularly following a professionally prescribed spinal health and fitness plan for the past number of months:*

10) On average, over the past 30 days, I would rate my overall level of PSYCHOLOGICAL/EMOTIONAL STRESS as (0= very low, 10= very high:*

11) On average, over the past 30 days, I have consumed/used TOBACCO PRODUCTS (cigarettes, chewing tobacco, pipes, cigars) the following number of times per DAY:*

Lifestyle Spinal Stressor Load Tool

Is Chiropractic right for you?

Calculate Your BMI For Adults

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