Forms

  • Welcome Letter
    Welcome! Thanks for getting started with Nutrition Counseling. Please read and initial.
    Download
  • Nutrition History and Assessment
    A history and personal assessment gives us a good place to start. Please take some time to fill out this form as completely as possible before your visit.
    Download
  • Client Profile
    General personal and insurance information. Please complete, sign, and date.
    Download
  • Release of Information Form
    This release form allows information to be shared with your other healthcare providers (as desired).
    Download
  • HIPAA
    The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rules govern how your personal data can be used. Please read and sign this document to acknowledge that you've received a copy of these rules.
    Download

Preparing for your visit

Prior to your first appointment, please print off and fill out the following forms. Having these completed ahead of time will allow us to optimize our time together during your session.

If you are unable to complete the forms ahead of time, please let me know and I will provide them for you in the waiting room. Please plan to come 20 minutes early in this situation.

(Guests with Adobe Reader can complete several of these forms online. Visit the Adobe Website to download the latest version of Adobe Reader if needed.)