Welcome To SHIN Wellness

Our questionnaire is designed to help figure out which service(s) will be right for you. Please take a moment to let us know how we can help. Once complete we will respond shortly.

All of us at Shin are so excited to be a part of your Wellness!

Please check all that apply below:

Nervous System

Anxiety

Vertigo

Headaches

Migraines

Blurred vision

Loss of smell

Loss of taste

Ringing in ears

Depression

Lack of focus

Fatigue

Sleeplessness

Procrastination

Memory loss

Light sensitivity

Seizures

Sound sensitivity

PTSD

Irritability

Past emotional abuse

Other

This field is required.

Muscle Skeletal

Neck pain

Mid-back pain

Low-back pain

Radiating Pain/Tingling/Numbness in arms/legs

Shoulder L

Shoulder R

Elbow L

Elbow R

Wrist L

Wrist R

Hand L

Hand R

Hip L

Hip R

Knee L

Knee R

Ankle L

Ankle R

Foot L

Foot R

Head Feels Heavy

Limited Motion

Swollen Joints

Loss of grip/strength/other

This field is required.

Reproductive/Endocrine

Night Sweats

Hormonal Imbalance

Difficulty Conceiving

Difficulty W/Sexual Performance

Difficulty W/Body Regulation

Weakness

Elevated Blood Sugar

Low Blood Sugar

This field is required.

GI/Excretory/Immune

Indigestion

Overweight

Underweight

Bloating

Constipation

Diarrhea

Food Allergies

Abdominal Pain

Frequent Urination

Painful Urination

Blood/Mucus in Stool

Blood Mucus in Urine

Lack of Bladder Control

Hemorrhoids

Frequent Colds/Flu/Sickness

This field is required.

Skin

Acne

Abnormal Pigmentation

Dryness

Itchy Patches

General Itchiness

Redness

Red Patches

Cracked Skin

Oily Skin

Pale Skin

This field is required.

Any Other Symptoms You Want To Tell Us About? This field is required.

First Name * This field is required.

Last Name * This field is required.

Email * This field is required.

Phone * This field is required.

Prolific Entrepreneurs