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8690 West Pahs Rd. Michigan City, IN 46360
219-872-5151
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Eaton Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or 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 Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!  Click link below to complete and submit your New patient Intake form online.

Download & Print Form #1

Download & Print Form #2

Download & Print Form #3 Must be completed entirely


Personal Injury Health History - Required for Motor Vehicle Accidents

This form is for any patient who is using car insurance for services

Download & Print Form #1

Download & Print Form #2

Download & Print Form #3 Must be completed entirely


ACN Paper Work-

Patient Health Questionaire- (Required for all United Health Care Patients)

Fill out this form if and only if you carry United Healthcare Insurance.  Bring it with you on your first visit.  This form is required by your insurance before they will authorize treatment.

Download & Print Form

Neck Disability Index- (Required for United Health Care Patients only if you have neck pain.)

Fill out this form if and only if you carry United Healthcare Insurance.  Bring it with you on your first visit.  This form is required by your insurance before they will authorize treatment

Download & Print Form

Low back Disability Index- (Required for United Health Care Patients only if you have low back pain.)

Download & Print Form

Indiana DOT CDL Physical Form- (Required for New or Recertification of indiana CDL Drivers License.) Complete section one and bring to appointment.

Download and Print Form

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!


Download the Free AdobeReader®


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 office. You can print it out and bring it in to our office or

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