Share your story with us

    Share Your Story With Others

We would love to have you share your story with all of our patients and future patients.  Please print this form off and either Email, Fax, or Mail it back to us after you have answered the questions.  Thank you so much for sharing your story for the benefit of others!!!

Schneider Clinic P.C.   

57340 Alpha Dr.

Goshen, IN  46528

Fax:  574-875-3232

Email:  info@schneiderclinic.com

Success Story

   1.  What problem or problems did you come to see Dr. Schneider for?   

    2.   What specific benefits have you received as a result of your treatments?   

    3.  What would you say to someone who is thinking about becoming one of Dr. Schneider’s  patients?   

   4.  What type of problems did you avoid by receiving your treatment?

   5.  What is the difference between being Dr. Schneider’s patient, versus other doctor’s you have    visited?   

   6.  Describe your occupation and type of work you do.

   7.  What hobbies or daily activities can you do now that you couldn’t do or avoided because of your problem(s)? 

Thank you for your time in completing this for our patients and future patients!  

 Please sign this form and date it so we may share your information and name with other patients and potential patients.    

Signed:  ______________________________________  Date:____________