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Online Forms

Nill Family 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

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!

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Dear friends, family, and patients;

I opened up Nill Family Chiropractic & Wellness Center in March of 2004 and have treated over 6000 patients. After almost 20 years of business and building a great practice and a new friends I have decided to accept a full time position at the Fort Wayne VA. In order to do this I am needed full time so I have to do the unthinkable and close my practice at the end of the year. December 28th 2023 will be my last day and Nill Family Chiropractic & Wellness center will be permanently closed. If you are seeking further care I recommend the following chiropractic offices.
Fort Wayne Spine and Joint
(6215 Covington Rd, Fort Wayne, IN 46804) (260) 755-5953
Northeast Chiropractic
(4332 Flagstaff Cove, Fort Wayne, IN 46815) (260) 245-0460
Edgewood Chiropractic
Center ( 1114 W Cook Rd, Fort Wayne, IN 46825) (260) 483-5588
Lombardo Chiropractic
Center (4337 Flagstaff Cove, Fort Wayne, IN 46815) (260) 485-9300
Sincerely,
Dr. James P. Nill DC