"Chiropractor Posture Chart Template"

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Chiropractic Posture Chart 
Date:
Doctor: _________________________________________
Patient’s Name:
Ref #: __________________________________________
Date of Birth:
Age:
Gender:
Male
Female
Insurance Details: ________________________________________________________________________________
 
Standing Posture
Scoring
Body Parts
L
R
Head
Neck
Shoulders
Upper Back
Lower Back
Spine
Torso
Abdomen
Hips
Knees
Ankles
 
 
Prone Posture
Supine Posture
Scoring
Scoring
Body Parts
Body Parts
L
R
L
R
Head
Head
Neck
Neck
Shoulders
Shoulders
Upper Back
Upper Back
Lower Back
Lower Back
Spine
Spine
Torso
Torso
Abdomen
Abdomen
Hips
Hips
Knees
Knees
Ankles
Ankles
 
 
www.FreePrintableMedicalForms.com
 
 
Chiropractic Posture Chart 
Date:
Doctor: _________________________________________
Patient’s Name:
Ref #: __________________________________________
Date of Birth:
Age:
Gender:
Male
Female
Insurance Details: ________________________________________________________________________________
 
Standing Posture
Scoring
Body Parts
L
R
Head
Neck
Shoulders
Upper Back
Lower Back
Spine
Torso
Abdomen
Hips
Knees
Ankles
 
 
Prone Posture
Supine Posture
Scoring
Scoring
Body Parts
Body Parts
L
R
L
R
Head
Head
Neck
Neck
Shoulders
Shoulders
Upper Back
Upper Back
Lower Back
Lower Back
Spine
Spine
Torso
Torso
Abdomen
Abdomen
Hips
Hips
Knees
Knees
Ankles
Ankles
 
 
www.FreePrintableMedicalForms.com