Merrillville Chiropractor
Place

3610 W. 80th Ln
Merrillville, IN 46410

219-769-5433

Call Us Today

(219) 769-5433

Schedule a Consultation
Merrillville Chiropractor
Place

3610 W. 80th Ln
Merrillville, IN 46410

219-769-5433

Call Us Today

(219) 769-5433

Schedule a Consultation
  • Home
  • Patient Paperwork
    • Becoming A Patient
    • Frequently Asked Questions
    • Contact
  • Experience
    • About the Doctors
    • About our Book
    • Reviews
  • Services
    • Fix My Low Back Pain
    • Ensure Natural Pregnancy/Pediatric Care
    • Growing Natural Healthy Kids
    • Enhancing Sports/Athletic Performance
    • Reversing My Arthrites
    • Creating Nutritional Wellness
    • Non-Surgical Spinal Decompression
  • Blog
    • Our Radio Show – Podcast
    • Video
  • Exercises
Menu
  • Home
  • Patient Paperwork
    • Becoming A Patient
    • Frequently Asked Questions
    • Contact
  • Experience
    • About the Doctors
    • About our Book
    • Reviews
  • Services
    • Fix My Low Back Pain
    • Ensure Natural Pregnancy/Pediatric Care
    • Growing Natural Healthy Kids
    • Enhancing Sports/Athletic Performance
    • Reversing My Arthrites
    • Creating Nutritional Wellness
    • Non-Surgical Spinal Decompression
  • Blog
    • Our Radio Show – Podcast
    • Video
  • Exercises
  • Home
  • Patient Paperwork
    • Becoming A Patient
    • Frequently Asked Questions
    • Contact
  • Experience
    • About the Doctors
    • About our Book
    • Reviews
  • Services
    • Fix My Low Back Pain
    • Ensure Natural Pregnancy/Pediatric Care
    • Growing Natural Healthy Kids
    • Enhancing Sports/Athletic Performance
    • Reversing My Arthrites
    • Creating Nutritional Wellness
    • Non-Surgical Spinal Decompression
  • Blog
    • Our Radio Show – Podcast
    • Video
  • Exercises
Menu
  • Home
  • Patient Paperwork
    • Becoming A Patient
    • Frequently Asked Questions
    • Contact
  • Experience
    • About the Doctors
    • About our Book
    • Reviews
  • Services
    • Fix My Low Back Pain
    • Ensure Natural Pregnancy/Pediatric Care
    • Growing Natural Healthy Kids
    • Enhancing Sports/Athletic Performance
    • Reversing My Arthrites
    • Creating Nutritional Wellness
    • Non-Surgical Spinal Decompression
  • Blog
    • Our Radio Show – Podcast
    • Video
  • Exercises
Search
Close
logo

Forms

Home → Best Chiropractor Near Me in Merrillville, IN → Forms

* = Required new patient forms. You may call the office for help at any time during business hours.

Adult

  • New Patient Form *
  • Low Back Pain Questionnaire
  • Neck Pain Evaluation Form
  • Auto Accident Form (Fill out if involved in an automobile accident.)

Spanish

  • INFORMACION CONFIDENCIAL DEL PACIENTE *
  • CUESTIONARIO DEL ACCIDENTE

Child

  • New Patient Form * (Fill out for each child.)

Pregnant

  • History of Pregnancy * (Fill out with New Patient Form if you are pregnant)
DrMattblackwhitte

SIGN UP NOW FOR OUR NEWSLETTER AND GET ACCESS TO MY EXCLUSIVE "GENETICS AND DECEIT" ONLINE VIDEO.

REINVENT HEALTHCARE

dvd3box

Enter Your Email Below:

Tags

ancestral health movement brain health chiropractic chiropractor Chronic illness crownpoint chiropractic crownpoint chiropractor DDD Diet emotional intelligence epigenetics GMO griffith chiropractor Healthcare huntergatherer industrialization Inspire chiropractic Kids lifestyle Meat Merrillville chiropractic Merrillville Chiropractor movement Natural Health No Bread Challenge Nutrition nutritionism paleo pediatric chiropractic Pediatrics pillars blueprint positive psychology Posture Pregnancy care pregnancy chiropractor Species Concept Spinal hygiene stress the pillars blueprint think Valparaiso chiropractic Valparaiso chiropractor Video Websters technique Wellness

CONTACT INFORMATION

browserlogo
  • 3610 W. 80th Ln
    Merrillville, IN 46410
  • (219) 769-5433

Merrillville

Office Hours:

Valparaiso

By Appt. Only

Mon

Tues

Wed

Thu

Fri

Sat

Sun

9AM – 6PM

9AM – 6PM

2PM – 7PM

9AM – 6PM

Closed

Closed

Closed

We Accept Most insurance

Accept Credit Cards
Review US
Facebook Twitter Instagram

Copyright © 2003-2021 New Life Family Chiropractic Center, PC Privacy Legal Training Accessibility Notice _ _ _