Online Forms

Paunicka Chiropractic Clinic offers our patient form(s) online so they can be completed 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.
  • Completed form(s) can then be brought 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!

New Patient Form


Download the Free Adobe Reader®

Our Locations

Office Hours

Monday:

8:00 am-2:00 pm

4:00 pm-6:00 pm

Tuesday:

8:00 am-2:00 pm

Wednesday:

8:00 am-2:00 pm

4:00 pm-6:00 pm

Thursday:

8:00 am-12:00 pm

Friday:

8:00 am-2:00 pm

4:00 pm-6:00 pm

Saturday:

Closed

Sunday:

Closed

Testimonials

Reviews From our Satisfied Patients

  • "Dr. Mark is great. He has helped me twice with a pinched nerve. Last year I was in so much pain I could barely walk. He takes the time to explain the treatment. Everybody in the office are very friendly and helpful. Always enjoy discussing Purdue and the Illini. Love the Illini Treatment Room!"
    Arlene
  • "I am lucky to have been in the care of both Doctors Paunicka for several years. Their care has allowed me to continue to walk and even dance!! My husband's spine surgeon approved and recommended Dr Paunicka! For the pain in my neck, back and lower back, I know that they will be able to help me. Having been to others, I can most highly recommend them to all!!!. My sincere thanks for the wonderful care!! It has saved my life!!!"
    Janice