New Patient Forms
  • Covington 425.690.3521
  • Maple Valley 425.690.3522
  • Enumclaw 360.825.7411


Thank you for your interest in Pinnacle's nutritional services. If we are billing insurance, please fill out the insurance information below to help with the scheduling process. All of this information will be kept confidential and will be used to provide an accurate cost estimate depending on your insurance plan. Please fill out the form to setup a 90-minute evaluation and we will get back to you shortly.

Name *
Date of Birth *
Phone *
E-mail *
Preferred Location *
How did you hear about us? *
Sign up for Pinnacle's monthly newsletter *
Monthly newsletter with Nutrition, Fitness & Wellness information
Insurance Company *
Example: Regence, Premera
Insurance ID # *
Starts with three letters
Insurance Group # *
Referring Physician *
What are we treating? *
Question/Comments *

It is important to know that physical therapy can be provided only by qualified physical therapists or by physical therapist assistants working under the supervision of a physical therapist.

Call Pinnacle at 360-825-7411 to learn how we can help you.