Client Forms

Please print and complete these before your first appointment.

New Client Packet. Provide your information and review the Client Financial Responsibilities and Other Policies including a Release of Liability. This must be signed prior to beginning coaching or counseling.

Eating Attitudes Test (reproduced with permission): Please complete and bring to your first appointment.

HIPAA and Privacy Notice. This explains our privacy practices and HIPAA policies.

Medical Provider Referral Form: If you are seeing an RD due to a physician’s referral or have Medical Nutrition Therapy needs, you will need to request your physician complete the bottom portion of this form. Need for this will be discussed during your appointments.

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