New Patient Intake Form

Pinnacle’s New Patient Intake Form is my first chance to show you how well I listen. Click on the link below to open it up.


This form is an editable PDF. After you open the form, save it to your computer, and then open the file. When you’re finished, save the document again, and print it to bring to the office for your first appointment.

It’s an 11-page form, so please allow yourself plenty of time to complete it thoroughly so that I have as complete a picture as possible of your background, your health, and your aches and pains.

If your computer doesn’t have the software to allow you to complete this form or to save it once you’ve completed filling it out, feel free to either:

a) print out a copy and complete it by hand

b) complete it on your computer and print it out

In either case, you can bring it with you when you come to the Pinnacle office for your appointment.

If you have the capability of signing it electronically, I would encourage you to do so. Otherwise, you can just type your name in the appropriate field and then sign the hard copy.

If you have any questions, don’t hesitate to call me at 303 502 4450