"DR. NICHOLAS R. SPANO
    Family Chiropractor


Health From Within. . . Naturally
94 East Union Street
Canton, Pennsylvania 17724
(570) 673-3886
 


To:___________________________________                     Re:___________________________________
      ___________________________________                     Patient:________________________________
___________________________________                    
Date of Occurrence:______________________
Att:___________________________________                     
File No:________________________________
                                                                                                
Date of this Report:_______________________ 

History   __________________________________________________________________

X-Ray Examination __________________________________________________________________

Analysis  __________________________________________________________________

Corrective Care __________________________________________________________________ Currently under corrective care_________________________________
Currently under stabilizing care to strengthen area of involvement and soft tissue______________________________________________
Currently under periodic care because of reoccuring symptoms associated with spine and relieved subsequent to care____________________________________
Currently under maintenance care________________________________
Progress  Very___ Good___ Slow___ Erratic___
Poor___ Improving as expected___ Improvement impaired due to__________________________________________
_________________________
Prognosis  Spinal correction complete__________________________________ Spinal correction anticipated, but length of time required is not know
at this time_____________________________________
Complete correction is not expected
Reason:__________________________________________ _____________________________________________________

Remarks   _____________________________________
 

Signed_______________________________________