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client forms

First Appointment Forms

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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] 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.

Diagnosis Code Form (for Superbill)

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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.

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