Online Forms

Chiropractic Care & Wellness Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary forms, print it out and fill in the required information.
  • E-mail your forms to, fax to (260) 434-0835, or bring them with you to your appointment.

New Patient Intake Forms - Required

This lets us know the history and current state of your health. Please fill out the following forms and bring the completed paperwork to your first visit.

New Patient Forms

Personal Injury Intake Paperwork

We cannot except all auto accident cases in our office. Please discuss your specific case before scheduling an appointment.

If you have recently been in an auto accident, the following corresponding forms are also required: 

Auto Accident Forms

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