Rehl Chiropractic
Michael Rehl, DC
1280 Boulevard Way #211
Walnut Creek, CA 94595
(925) 330-3326
First Name*
Last Name*
MSK Solutions
Do you eat less than 9
servings of fruits and
vegetables daily?
Do you get frequent
colds, flus, diarrhea,
constipation, bloating,
Do you take any
medication for pain,
inflammation, diabetes,
blood pressure or
Do you frequently consume
refined, sugary foods,
sweets and soda?
Do you eat grain
products, white bread,
pasta, cereal, chips and
crackers daily?
Do you eat fried foods,
fast foods and packaged
foods daily?
Do you smoke or consume
excess alcoholic
beverages frequently?
Is exercising frequently
a challenge for you?
Have you experienced
physical trauma
throughout your lifetime?
Do you experience pain or
limitations with basic
tasks (bathing, dressing,
cleaning, yard work)?
Do you struggle with
falling asleep, staying
asleep or oversleeping?
Do you feel down,
depressed or have mood
Do you feel tired,
fatigued or have low
Do you have a poor
appetite, overeat or have
difficulty losing weight?
Do you feel anxious,
worried, nervous,
irritable or restless?
Do you feel isolated from
friends and family?
Do you struggle with
focus, concentration or
poor memory?

Disclaimer: This tool does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read here or anywhere online. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Privacy Policy
Rehl Chiropractic
1280 Boulevard Way #211 Walnut Creek, CA 94595
(925) 330-3326
Powered by Drip-Education® System