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Systems Survey Form

A systems survey form by Standard Process to document symptoms

Supplements additional fee

Download & Print Form  (Fill out & send back)

$95

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"The doctor of the future will give no medication but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease"   – Thomas A. Edison (1847-1931)

Adjustments 35-65, Examinations 45-65, Physicals 45-65, BioResonance Testing 125-375, Custom Orthotics 225-425

Hours: Monday-Friday 8-5:30 by appointment; Weekends by appointment

TEXT (Fastest Response) OR CALL: Dr. Erika 218.770.3393

EMAIL US: nourish@docerika.com

225 W. Lincoln, Suite #107, Fergus Falls, MN 56537

© 2019 Nourish Chiropractic

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Medical Disclaimer: All information contained within this guide is for informational purposes only. It is not intended to diagnose, treat, cure, or prevent health problems – nor is it intended to replace the advice of a qualified medical practitioner., health practitioner or fitness professional No action should be taken solely on the contents of this guide. Always consult your physician or qualified health professional on any matters regarding your health on any opinions expressed in this program. The information provided within this guide is believed to be accurate based on the best judgment to the author, but the reader is responsible for consulting with his or her own health professionals on any matters raised within. We do not assume liability for the information contained within this guide be it direct indirect, consequential special exemplary or other. It’s advisable to consult your physician before changing your diet, starting an exercise program, or taking supplements. 

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