(574) 258-4444

Our Mishawaka, IN Office

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Michiana Wellness & Longevity Clinic

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Appointments

Chiropractic Patient Forms

These are our Downloadable Forms:

  • New Patient Checklist
  • MWLC Intake Form
  • Wellness Check
  • General Pain Disability Index Questionnaire
  • Neck Disability Index
  • Owestry Low Back Pain Disability Questionnaire
  •  Roland-Morris Acute Low Back Pain Disability Questionnaire
  • HIPAA form
  • Health Appraisal Questionnaire
  • Records Release form
  • Clinic Policy In NP Agreement
  • Insurance Verification
Michiana Wellness & Longevity Clinic

Location

605 W Edison Rd, Suite G
Mishawaka, IN 46545

Phone: (574) 258-4444

Office Hours

Monday 12:00 am – 6:00 pm
Tuesday 12:00 pm – 6:00 pm
Wednesday 12:00 am – 6:00 pm
Thursday 12:00 pm – 6:00 pm
Friday 12:00 am – 6:00 pm
Saturday By appointment only
Sunday Closed

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