Form Downloads and Links

Commonly Used Forms


Forms Available on HealthView


The following forms can be downloaded in English or Spanish at healthview.pinnacletpa.com.

  • Enrollment Card
  • Coordination of Benefits Form
  • Initial COBRA Notification, Continuation of Rights
  • COBRA Notification, Continuation of Rights
  • FSA Enrollment Form
  • FSA Reimbursement Claim Form
  • Medical Claim Form
  • Dental Claim Form
  • Accident Detail Letter
  • Explanation of Benefits Sample
  • Health Evidence Form
  • Pinnacle Rx Solutions Mail Order Form
  • Pinnacle Appeal Forms
  • Glossary of Health Coverage and Medical Terms