Complaint(s)	Date Updated	Updated By	View	Edit	Remove
<%#DataBinder.Eval(Container, "DataItem.complaint")%>	<%#DataBinder.Eval(Container, "DataItem.dateUpdated","{0:dd/MM/yyyy}")%>	<%--<%#DataBinder.Eval(Container, "DataItem.updatedBy")%>--%>

Complaint(s)	View	Edit
<%#DataBinder.Eval(Container, "DataItem.complaint")%>

Complaint	View	Edit
<%#DataBinder.Eval(Container, "DataItem.complaint")%>

Complaint

When did the problem begin

When is the problem at its worst

Indicate the type(s) of discomfort (select all that apply)

The frequency of your discomfort

Indicate your pain level (0 = No Pain / 10 = Worst Pain)

Your discomfort increases with (select all that apply)

Your discomfort decreases with (select all that apply)

Problem injury related?

How did the injury happen?

Problem accident related?

Spinal injury (minor / major)?

Been to another Chiropractor?

Which Chiropractor?