TELENUTRITION CLIENT FORMS

The forms below must be filled out and returned prior to your first Telenutrition appointment. 


Please sign and return all forms by scanning and emailing to Blandnutricia1@gmail.com or by postmark to L.E.A.N. Consulting, 13506 Arbolado Ct, Bakersfield, CA 93314. 

PATIENT PERSONAL INFORMATION

Download, Fill Out & Return

FINANCIAL RESPONSIBILITY ACKNOWLEDGEMENT

Download, Fill Out & Return

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

This form is for your records.

HIPAA ACKNOWLEDGEMENT

Download, Fill Out & Return

 

READY FOR YOUR APPOINTMENT?

You can access your Telenutrition session from your computer, cell phone, or tablet as long as you are connected to the internet. Upon clicking the link below, you will be asked to enter your name. Your first name only is fine. Once provided, click "Check In".

Please be sure to allow access to your camera and microphone on the device that you are using. Push enable camera and microphone "Allow". Your session will begin at your scheduled appointment time!