diff --git a/src/Components/PatientForm/FamilyFormSection2.tsx b/src/Components/PatientForm/FamilyFormSection2.tsx index f1ad09c..b73a92d 100644 --- a/src/Components/PatientForm/FamilyFormSection2.tsx +++ b/src/Components/PatientForm/FamilyFormSection2.tsx @@ -101,7 +101,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip - + - + - + - + - + - + Spouse's Information: - + - + - + - + - + - + - + - + - + - + - - + + Chiropractor Information: - + Previous Chiropractic Care: - + - + - + - + - + - + Please list current supplements or drugs you may be taking: - + Do you excercise? - + - + Use tobacco? - + - + Consume alcohol? - + - + Have a healthy diet? - + - + Get adequate sleep? - + - + Is Work/School stressful to you? - + - + Family life stressful to you? - + - + Use recreational drugs? - + Please choose body areas or systems where you may have problems: - + Eyes - + Intestines/Bowls - + Joints/Bones - + Allergies - + Ears, Nose, Mouth, Throat - + Urinary - + Skin - + Psychological/Emotional - + Heart - + Muscles - + Internal Organs - + Gynecological menstrual/Brest - + Lungs/Breathing - + Nerves - + Blood - + Prostate/Testicular/Penile