- Nutrition First
- Because it matters.
Please print out these forms, fill them out, and bring them with you to the office; that will allow us to focus all of our time on your nutritional needs during your first visit.
Health
Assessment
This form describes your health history, normal food intake, and activity level. It is critical input to your personalized nutrtion plan.
Payment for Services
This form describes your responsibility for payment in the event that your insurance does not cover nutrition counseling for your situation.
Consent for Sharing Health Information
This form provides your consent for us to share information with any other health provider that you would like to participate in your care.
This form describes your health history, normal food intake, and activity level. It is critical input to your personalized nutrtion plan.
Payment for Services
This form describes your responsibility for payment in the event that your insurance does not cover nutrition counseling for your situation.
Consent for Sharing Health Information
This form provides your consent for us to share information with any other health provider that you would like to participate in your care.
Please use this form as a guide when contacting your insurance company. Please bring the completed form to your appointment and I will make a copy for your file; it can be useful if we need to dispute an insurance claim payment denial.
