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Patient Forms

Thank you for bringing Summit Vitality onto your health care team! Below you will find all the forms you will need for your first visit. Please download, fill them out, and bring with you to the visit.

First Visit Check List

- Adult or Child intake form
- HIPPA Form
- 7 day health diary - you will not need to fill this out yet
- Policy Forms

Pediatric Intake Form

Required for new patients under 18 years of age.

Adult Intake Form

Required for new patient 18 and older.

Privacy Policies (HIPPA)

Required for all new patients.

7 Day Health Diary

Required for new patient visits, useful for anyone!


Required for new patients and guardians.

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