Forms

Please complete the following forms and bring with you to your first visit.

Initial Client Contract (including payment and HIPAA policies)

Medical Nutrition Therapy (MNT) Referral Form

Initial Client Information & Release Form

Initial Nutrition Assessment Questionnaire

Resources

Families Empowered And Supporting Treatment of Eating Disorders (FEAST-ED)
http://www.feast-ed.org

National Eating Disorder Association (NEDA)
https://www.nationaleatingdisorders.org

Valley Federation of Eating Disorder Professionals (VFEDPro)
http://vfedp.org

Academy of Nutrition and Dietetics (AND)
http://www.eatright.org

Sports Cardiovascular And Wellness Nutrition (SCAN)
Dietetic Practice Group of AND
https://www.scandpg.org

American College of Sports Medicine (ACSM)
http://www.acsm.org

Choose My Plate
https://www.choosemyplate.gov

Ellyn Satter Feeding Institute
http://www.ellynsatterinstitute.org

Sheri Barke's HIPAA Notice of Privacy Practices
HIPAA NOTICE OF PRIVACY PRACTICES