New Client Forms

New Patient Packet
Please print, review, sign and bring these forms with you to your first appointment.
New Patient Packet 2016.pdf
Adobe Acrobat document [379.2 KB]
Initial Session Assessment Form
Please complete the form on your computer and return via email 1-2 days prior to your appointment. You may also fax the form to (562) 490-8582. Allowing the dietitian to review this ahead of time will save valuable time during your session.
Adult Intake Questionnaire 2016.docx
Microsoft Word document [174.5 KB]

Payment

Payment is due at the time of service in either cash, personal check or credit card. Prices are listed under Services & Fees.

 

Eat Freely Nutrition does not accept insurance at the present time but can provide you with an official receipt of services which you can submit directly to your insurance company. Please ask for a Superbill at every visit.

Confidentiality

All sessions are held in strict confidence. With respect to your privacy, a release form will be used to obtain permission to speak with your physician or psychotherapist. 

Contact Us Today!

1777 N. Bellflower Blvd.

Suite 205

Long Beach, CA 90815

Phone: (562) 298-0042

Fax: (562) 490-8582

info@eatfreelynutrition.com

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