
The first step in booking an appointment is completing the Intake and Service Option Form, which provides me with basic information about you and the nutrition support you are seeking, so I can prepare for your appointment.
Getting Started is as easy as 1-2-3
Complete the form in point form. Please do not put more information in the boxes than they hold, as this makes the form unreadable once received. If you have complex clinical needs and require more room to list diagnoses or medications, an additional page is available below.
You only need to complete 3 pages: the first two and the last. The other pages list available services for you to tick off the one(s) you want.
Short on time now? Both options below provide a link so you can email the form to yourself and complete it later.
OPTION A: Book Online
Complete the Intake and Service Option Form
Need More Room to List Diagnoses or Medications?
For boxes where more space is needed, such as diagnoses & dates, medications, etc., please download the “Additional Health Information Form” to your computer, fill it in, then drag and drop it to the end of the online Intake and Service Option Form, or email it to our office later.
OPTION B: Book via Email or Fax
Download and Complete the Intake and Service Option Form Manually
Click Here to Download Form & Step-by-Step Instructions
1. Download the Form
Download the Intake and Service Option Form (dated June 1, 2026) to your computer.
NOTE: All boxes on the form need to be completed because we need this information to understand your needs to set up an appointment. For this reason, incomplete forms will be returned.
✉️ On your phone? Email this PDF link to yourself to open later on your computer
If you want a password-protected form, please send us a note through the Contact Us form, and we will send one.
2. Complete the Form
Complete all the boxes on the form on your computer, tablet, or smartphone. For a Windows device, use the free Adobe Online tool, or for a Mac device, use Preview.
Need help? Step-by-Step Instructions here.
3. Email or Fax Your Documents
Email your completed Intake and Service Option Form to the address on the first page of the form, or request our fax number.
- Please do not scan the form before sending it, as it is needed ‘as is’ for our charting and accounting system.
Please feel free to redact your healthcare number on lab work before sending, or to fax the documents directly to our office.
NOTE: If sending Intake and Service Option Forms for more than one person, please send them in separate emails, with the relevant attachments.
