Wholistic Health Center
Your East Bay Car Accident & Work Injury Information Center
Fremont Office        510.796.1288
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Car Accident Survey
Work Injury Survey
If you live in the San Francisco California Area and you've been injured in a car accident or on the job, please take our online survey & read through the information on our website to find out more about your rights and our services.
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Car Accident Survey

The purpose of this survey is to help isolate and identify accident related symptoms that you may be experiencing at this time. By completing this survey, we will be able to help you once we see you in our office or answer any questions that you may have prior to your visiting us.
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The information presented on this web site is for general informational purposes only. Nothing contained in this site should be considered legal advice. You should speak to a lawyer to address any specific questions about your particular case. We cannot diagnose your problem over the phone. We will need to see you in our office for further evaluation. We are located in the San Francisco Bay Area in the State of California.

If you are experiencing any of these symptoms you might be injured
from your car accident. Call our office to schedule an appointment.
(510) 796-1288 Fremont
Please tell us about the symptoms that you are having:
Your Name
Insurance Company
Date of Accident
Your Phone Number Area Code + Number
Best Time to Contact You
Your  Email Address
Please tell us about about you and how to contact you:
Questions? Comments
Headache
Mid-back pain/stiff
Elbow pain/stiff
Ankle/foot pain
Sleeping problem
Dizziness
Feet cold
Hands cold
Stomach upset
Constipation
Neck pain/stiff
Lower back pain/stiff
Wrist pain/stiff
Numbness in fingers
Nervousness
Head Seems too heavy
Shortness of Breath
Fatigue
Depression
Light bother eyes
Chest pain
Shoulder pain/stiff
Thigh/knee pain
Numbness in toes
Tension/Irritability
Face flushed
Buzzing in ear
Loss of balance
Fainting
Loss of Smell
Cold sweats
Loss of memory
Loss of taste
Fever
Ears ring
Diarrhea
Please contact me to schedule an appointment
I live in the San Francisco Bay Area and have questions, please call me