client forms

Back to Services >

Please download and complete these forms prior to your first office visit. (If you have already scheduled an appointment, these forms have been emailed to you.) Once complete, email them to your nutritionist at [name]@ViTLnutrition.com ahead of time. If you are unable to email these forms, please bring them with you to your first appointment. If we do not receive these forms ahead of time, we may have to spend the first few minutes of your appointment reviewing them.

First Appointment Forms

< click to download

Diagnosis Code Form (for Superbill)

< click to download

If you choose to seek reimbursement from your insurance company, you may request a superbill to submit to your insurer. Please note that your insurance company may or may not pay for your visit. In order to provide you with a superbill, we require the proper referral information from your physician. This includes the Diagnosis Code Form (above) to be completed by the patient and physician. It is your responsibility to obtain the proper referral prior to your visit and bring it with you.

  • HOME

  • SERVICES

  • ABOUT

  • CLIENTS & CASE STUDIES

  • CONTACT

  • More

    BLOG + RECIPES

    ViTL Nutrition

    17924 140th Ave NE, Suite 230

    Woodinville, WA 98072

     

    (206) 920-1973 

    contact@ViTLnutrition.com

    www.ViTLnutrition.com

    Contact

    In-office & online appointments available.

     

    Proud to serve Woodinville, Bothell, Redmond & Kirkland

    since 2012! 

     

    © ViTL Nutrition, 2018

    Susan Lewis MS, CN

    susan@ViTLnutrition.com

     

    Scott Littlefield MS, CN, CISSN

    scott@ViTLnutrition.com

    ​

    Fitness-Minded, Research-Driven

    Nutrition Counseling

    About