Thank you for choosing Pinnacle Peak Podiatry!
Below you will find our New Patient Forms that you will need to fill out and bring with you to your first appointment.
Instructions:
- Click a button to open a PDF form on the right.
- Print the PDF form and repeat steps 1 and 2 until all forms are printed.
- Completely fill out all the forms and sign where indicated.
- Bring all completed forms to our office on your first appointment except the “HIPAA Notice of Privacy Practices” form. Please retain this form for your records only.
Questions?
Call us at (480) 563-5115
Download Patient Forms:
- Medical History PDF
- Patient Info PDF
- Consent for Treatment PDF
- HIPAA Acknowledgement PDF
- HIPAA Notice of Privacy Practices PDF (Please retain for your records)
- HIPAA Authorization Form PDF
- Financial Policy PDF
- Permission-to-Treat-a-Minor PDF (Optional)
- Permission-to-Accompany-a-Minor PDF (Optional)