New Patient Forms at Pinnacle Chiropractic

person filling out forms

Save Time During Your First Visit

At Pinnacle Chiropractic, we offer our paperwork online so you can complete it in the convenience of your own home, prior to your first appointment.

Please click on the appropriate link below based on your reason for visiting our office.

Email Pinnacle Chiropractic

Comments, Requests, Questions, or Suggestions

First Name

Last Name

Respond to me via:

Phone

No Response

Email Address

Phone Number

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Request Appointment (pending confirmation)

Patient Type

New Patient

Current Patient

Returning Patient

First Name

Last Name

Email Address

Phone Number

Respond to me via:

Phone

Preferred Day/Time:

Date

Appointment Hour

Appointment Minute

AM or PM

Comments or Questions

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I consent to having this website store my submitted information so they can respond to my inquiry. For more info, read our privacy policy.

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Pinnacle Chiropractic
289 E Main St, Ste A
Lehi, UT 84043
Phone: (801) 766-4741

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