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219-227-4033

Paun Family Chiropractic and Wellness, P.C. 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 form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Forms

New Patient Form (Chiropractic or Acupuncture) - Please bring this filled out to your first chiropractic/ acupuncture appointment.

Massage New Patient Form (Cash Massage only) - Please bring this filled out to your first massage appointment.

Nutrition New Patient Form - Please bring this filled out to your first nutrition appointment.

Hypnosis New Patient Form - Please bring this filled out to your first hypnosis appointment.

Auto Accident Forms - Please bring this form filled out if you were involved in an auto accident and will be billing to your, or a 3rd party, auto insurance.

DOT Commercial Driver Fitness - Please bring this form filled out to your Driver Exam appointment.


Pain Questionnaires

Please DO answer each question, please DO NOT total it at the bottom. You only need to print the questionnaire if told to do so by one of our office managers.

Low Back Questionnaire
Neck Questionnaire
Hip, Knee, Ankle Questionnaire
Arm, Shoulder, Wrist Questionnaire


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

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