Skip to content
 

New Patient Paperwork

 

The Chiropractic Rehab & Wellness Center offers patient forms you can download from the convenience of your home or office.

You may submit your new patient paperwork electronically, by Clicking Here, and your information will be sent directly to our office.

Or, you may print your paperwork to bring with you to your appointment.

All forms are PDF files. If you do not already have AdobeReader® installed on your computer, you can download it free by Clicking Here.

Just download the necessary form(s) below, print them out and fill in the required information. Fax us your printed and completed form(s) or bring it with you to your appointment.

Office Hours
Monday8:30am - 5:30pm
Tuesday10:00am - 5:30pm
Wednesday8:30am - 5:30pm
Thursday10:00am - 5:30pm
Friday8:30am - 4:30pm
Sat-SunClosed
Highly Recommended Chiropractor
What Our Patients Are Saying

"Dr. Miller is knowledgeable and thorough. He is personable and does a great job at addressing spinal issues and more."
- Gene

"What they do truly makes a difference in peoples lives everyday and has had made all the difference in my life!"
- Stephanie

"They take care of the problem and help you understand possible causes. They will also do rehab to help the issue as well, not just the adjusting."
- Jennifer

"I came in with migraines and Dr. Miller helped not only with adjusting my neck and back, but my overall health."
- Brock

"After a series of traction treatments my back is strong and well; two weeks after my first treatment with no rehab and a lot smaller bill!"
- Linda

"After 2 years of horrible sciatica, I am now pain free! I’m back to my old self!"
- Tonya

"I had tried everything and the Virgin Diet completely healed my IBS and I was feeling better within 2 weeks!"
- Shirley

"I believe strongly in the Virgin Diet coupled with Chiropractic Care that finally allowed me to be pain free after a year of constant pain."
- Christine

"When I follow Dr. Miller's instructions, I can have a relatively pain-free and joyful life. I get to keep my job, enjoy my grandchildren, sit comfortably, and sleep at night!"
- Lisa

“After my appointments, I can now be more active, sleep more comfortably, and focus better on my education without dealing with back pain. The Graston technique really helped with my scoliosis pain.”
- Daphne

“I suffer from Fibromyalgia. I have had a significant decrease in pain since I became a patient of Dr. Miller, and without prescription medications!”
- Jen

“As a dental hygienist since 1982, my back, neck, and posture have improved under Dr. Miller’s care. I also sleep better at night as a result of chiropractic adjustments!”
- Denise

“For years I have worked through the back pain that greeted me every time I started doing chores around my home. After only two treatments from Dr. Miller, I can honestly say that there was a significant change in the pain level I experienced. Since completing my treatment plan, most days I am pain free even while I am working around the house!”
- Marcos

“I have suffered from headaches since I was a teenager. I have never liked taking medication. I had done some research into alternative solutions. Acupuncture was not going to work since I don’t like needles. Chiropractic care sounded the most promising, but I never wanted my neck cracked. Since starting with Dr. Miller, I have only had a few headaches!”
- Tiah

Office Hours
Monday8:30am - 5:30pm
Tuesday10:00am - 5:30pm
Wednesday8:30am - 5:30pm
Thursday10:00am - 5:30pm
Friday8:30am - 4:30pm
Sat-SunClosed
Chiropractic Rehab & Wellness Center
The Chiropractic Rehab & Wellness Center
10528 Coldwater Rd
Fort Wayne, IN 46845
(260) 338-1700
Chiropractor
Share With Your Friends:
Recommended chiropractor