Patient Verify

PinnacleVerify

Complete the form below to register an account. Upone completion your credit card will be charged $2,500.00 for a one-time registration fee.

* Indicates a required field.

Enter practice information below.

Practice Name *

Practice NPI *

Practice E-Mail Address *

Practice Phone Number *

Enter administrator information below.

First Name *

Last Name *

E-Mail Address *

Password *

Password must be a minimum of 8 characters.

Enter credit card information below.

Card Information *

Card number, expiration date, and CVC will be collected securely by Stripe.

I agree with the terms & conditions and privacy policy.

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