If you would like us to submit to your insurance company for payment for sessions, this form MUST be completed before your first session. Diagnosis codes are required from your physician even if your insurance does not require a referral for nutrition care.
The Client Agreement form is required for all clients. For clients under 18 years of age, a parent/guardian must complete the form.
The EAT 26 is a questionnaire that looks at your attitudes about food. Complete this form if you are seeing Nicole to help with an eating disorder or disordered eating of any kind.
The Client Demographics form is required for all clients.
The insurance guide is to assist you if you'd like to find out more about your insurance company's coverage for nutrition care.