Nutrition Consultation Form

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Prior to scheduling your appointment, we ask that you complete and submit a nutrition consultation form. You may drop off the completed form at our Medical Center Front Desk, or you may fax a copy to (425) 861-6277.

Payment for sessions is required at time of service.

If you have a medically necessary reason to see a dietitian, we would be happy to bill your insurance company for the session. Please complete the Insurance Release form, and have your doctor complete the Doctor Diagnosis form and submit these at the same time you submit your completed Nutrition Consult form; otherwise, regular charges apply.