Forms

Please download all 3 of these intake forms to be completed prior to your initial consultation:

  1. LTLW Intake Form
    If your appointment is to discuss your entire family’s health, please complete this LTLW Intake Form for Families instead.
  1. Release of Personal Health Information
  2. Wellness Assessment

We will go through them together should you have any questions, but please complete them as best you can prior to the appointment.

If you are submitting to your insurance for reimbursement, you will need to get this Medical Nutrition Therapy Referral form completed by your doctor and dated prior to our initial consultation.