Joseph Manuel Ponce DO
have you needed to see a doctor or other health professional in the last 12 months?
are you currently taking any prescribed medication?
Please click the corresponding box below if you are suffering or have you in the last 5 years suffered from any of the following?
back or neck pain
other pain or injury (anywhere)
high blood pressure
circulatory disturbance, eg. varicose veins, leg swelling, cold extremities, etc
heart complaints: irregular beat, chest pain, etc
breathing difficulties: breathlessness, cough, wheezing, pain on breathing, etc
disturbance or changes in bladder habit
digestive complaints; disturbance or changes in bowel habit
skin, nail or hair changes
reduced bone density? eg. osteoporosis, osteopenia
disturbance or changes in eye-sight, hearing, taste, smell; dizziness and balance problems
sore or dry eyes and / or mouth
numbness or tingling in the arms, legs or face
muscular weakness; disturbance of balance or co-ordination; tremour
loss or gain in energy; difficulty with sleep
changes in weight; changes in appetite and/or thirst
anxiety; depression; other psychiatric diagnosis
have you EVER had any serious illness or medical condition which you have not aleady told us about?
have you EVER had any significant accident or injury which you have not aleady told us about?
have you EVER had any surgery which you have not aleady told us about?
Now hit the SUBMIT button
If you need to start again hit the RESET button
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