Insurance & Forms

Medical Nutrition Therapy (MNT) services provided by a Registered Dietitian are covered by most major health insurance policies and Medicare. We encourage you to contact your insurance provider prior to your appointment to verify your specific benefits and any applicable copays or deductibles.

Please complete the following forms prior to your first appointment. Submitting these in advance allows us to make the most of your time together and personalize your care from day one.

• New Patient Intake Form

  General health history, current medications, dietary habits, and wellness goals.

  Required for all new patients

• Medical History & Health Assessment

  Detailed medical background including diagnoses, surgeries, and family health history.

  Required for Medical Nutrition Therapy

• 3-Day Food & Activity Journal

  A record of everything you eat, drink, and your physical activity over three days.

  Recommended — complete before your first visit

• Insurance & Billing Authorization

  Authorization to bill your insurance provider for Medical Nutrition Therapy services.

  Required if using insurance

To receive forms electronically or for assistance completing them, please contact us directly.