Pregnancy History Chiropractic, Massage, Trigger Point Therapy, Salt Cave and more!Let us help you achieve your health goals! BOOK AN APPOINTMENT Leave this field blank PREGNANCY HISTORY DR. Janine D. Kelly (optional) 1762 Newbridge RoadBellmore, NY 11710(516) 409-0044 Today’s Date Name Sex Male Female Date of birth Age How many children do you have? What is the term of your pregnancy During your pregnancy, did you have any of the following High Blood Pressure Indigestion Seizures Swollen Ankles Diabetes Thyroid problems Heart issues Morning Sickness Back Pain Headaches Motor vehicle accidents Abnormal Bleeding DURING YOUR PREGNANCY, DID YOU USE ANY OF THE FOLLOWING Tobacco Alcohol Non-prescribed drugs Prescription medications Signature Start Drawing Clear Done Start Over Send
