David Brisson Osteopath D.O. Tokyo medical report

Home page Yokosuka Chiropractic

For David Brisson Osteopath D.O.

To get a global understanding of You and your trouble, and for safety purpose.

Family name, First name

Phone

Birthday

Day

Month

Year

Type of work, hobbies, sports | Children + ages

Describe your trouble: what, where, when, how... | Similar history and treatment | What increase or decrease the symptoms...

Upload photos, medical report...

approximative age + what + treatment + today state

"18yo, left tibia fracture, surgery, metal screw removed"

Fracture, sprain, dislocation, tendonitis...

Accident: car, bicyle, bike... | Injury: falls, stairs, ski, sport... | Impact on the head, coccyx | fainting...

Surgery, metals inside the body | Other hospitalisation

Diagnosed disease | Medical teatments

Abnormal outcome on MRI, Xray or blood check

Anything else to mention ? | Psycho-emotional history