Wholistic Health Center
Your East Bay Car Accident & Work Injury Information Center
Fremont Center        510.796.1288
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Car Accident Survey
Work Injury Survey
If you live in the San Francisco Bay 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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Work-Related Injury 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 California workers compensation or federal social security disability case.

If you are experiencing any of these symptoms, you might be suffering from work injury. Call our office for an appointment and FREE CONSULTATION. .
(510) 796-1288 Fremont
Please tell us about the symptoms that you are having:
Your Name
Employer
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
LOWER BACK
REPTITIVE STRESS DISORDER/ CARPAL TUNNEL SYNDROME
NECK PAIN
Localized low back pain
Pain upon sitting or standing
Muscle tension/stiffness
Swelling in low back/leg
Sleeping problem
Repetitive hand use
Neck pain/numbness
Elbow pain/numbness
Wrist pain/numbness
Working at a workstation for 5 or more hours
Back pain that travels to the leg and ankle
Joint stiffness
Knee/Leg Pain
Nervousness
Hand pain/numbness
Forearm pain/numbness
Shoulder pain/numbness
Swelling in extremity
Numbness/Tingling sensation in low back/leg
Muscle spasm
Lifting/Bending/Stooping produce pain
Extreme pain after working for 1 or more hours
Waking up at night because of extreme pain
Car Accident/ trauma
Numbness in hands
Hard time moving neck around
Please contact me to schedule an appointment
I live in the San Francisco Bay Area and have questions, please call me
Neck pain or stiffness
Shoulder pain
Pain travels from neck to elbows/fingers
Cannot bend neck
Dizziness
Headaches