Have you ever been to a healthcare professional only to be bogged down by many different forms to fill out taking 15 + minutes prior to seeing your healthcare provider? Nutrition with Heart is happy to provide all its forms here to help make your first session experience as seamless as possible. We are excited & grateful to have you as a part of our practice. Any questions or challenges with completing your forms please do not hesitate to contact us at 425-835-2900, or email at: Michael@Nutritionwithheart.com
Nutrition with Heart has made more than one option for filling out forms prior to the first appointment for greatest convenience. All forms to be completed are available as fillable pdf’s. This means you can fill them out right on your computer or you can simply print them and fill them out by hand, whichever you prefer.
Please Utilize The Option Listed Below that is Best For You:
E-sign = a form link will be emailed which can be completed & electronically singed online:
Download = simply click on the Nutrition with Heart logo to begin downloading your form:
Nutrition with Heart is happy to provide a medical benefits check of your insurance coverage for Medical Nutrition Therapy. Please just provide this completed form and Nutrition with Heart will respond to you with the information provided from your insurance company regarding your coverage in 48-72 hours.
This form provides permission for Nutrition with Heart to obtain and share medical information with your medical provider(s). The sharing of your information is not mandatory to work with Nutrition with Heart, and is only available to assist in the collaboration of your medical care if you would like.
The Practice Policies & Treatment Consent has all of the information you’ll need to begin conveniently located in one efficient and simple to fill out form.
The HIPPA Notice of Privacy form requires no filling out or signing. It a mandatory form to be provided to you about how your health information will be used and disclosed.
This journal is to assist in gaining insight into food and lifestyle behaviors. Journaling brings awareness, and provided dietetic and metabolic information helpful for guiding change.
This journal assists in gathering more detailed information about blood sugar responses with insulin dosages. It’s purposes is to better understand this relationship with food intake, insulin dosages, and blood sugar levels.
This provides and insightful look at our day-to-day physical activity & sedentary behaviors
This journal assists in gathering more detailed information about blood sugar responses with insulin dosages. It’s purposes is to better understand this relationship with food intake, insulin dosages, and blood sugar levels.