Give us a call today: (219) 476-7246 VIEW OUR LOCATIONS Request EvaluationRequest RefillLeave TestimonialOther ConcernsRequest Evaluation Request a New Patient Evaluation You will be contacted within 24 hours of submitting this request to schedule your initial evaluation. Name* First Middle Last Email* Phone*Preferred Location*Crown PointHobartLaPorteMunsterValparaisoDate of Birth* MM DD YYYY Request Refill Prescription Refill Request Full Name* First Last Email* Enter Email Confirm Email Phone*Date of Birth* MM DD YYYY Physician*Choose Your DoctorDr. Chetan PuranikDr. Daniel ChaDr. Simon HoDr. Rohit PuranikDr. Adrian SonevytskyOffice Location*Crown PointHobartLaPorteMunsterValparaisoPreferred Pharmacy*Pharmacy Street & City*Message Leave Testimonial Leave a Testimonial Name* First Last Email* Phone*Select a Physician*GeneralDr. Chetan PuranikDr. Daniel ChaDr. Simon HoDr. Rohit PuranikDr. Adrian SonevytskyDr. Dion SniderDr. Lakia BrownDr. Monish MerchantTestimonial* Confirmation of Use*Centers For Pain Control may share my testimonial, using my first name and last initial only. I agree with the statement above Other Concerns Contact Request Name* First Last Phone*Email* Subject*Message*
