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.
1. Complete the Form: Choose one of the two options below to complete the form. You only need to complete 3 pages: the first two and the last one. The other pages list available services for you to tick off the one(s) you want.
NOTE: All boxes on the form need to be completed. Incomplete forms will be returned.
2. Receive Confirmation: You will receive a written notification when the online form was successfully sent. If you didn’t receive confirmation it was because the form was incomplete.
3. Book an Appointment: Once we receive your completed form, you will receive an email from the Admin account to book your appointment.
Short on time now? Both options 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?
Below is how to submit additional information that does not fit in the boxes on the form:
- Complete the first 2 pages using bullet points to keep answers within the provided space. Do not exceed the capacity of the boxes as they become unreadable once sent. See the next step if you need more room.
- For boxes where you need more space (e.g., diagnoses & dates, medications), please download the “Additional Health Information Form” to your computer, fill it in, and save the file to your desktop with your name in the file name.
- Drag and drop the completed “Additional Health Information Form” to the end of the online form, or email it to our office later.
- Drag and drop a copy of your most recent complete blood test results as a downloaded PDF report at the end of the online form, or email it to our office later. Please do not send screen captures or JPEGS.
- Click “submit”. You’ll receive a confirmation message.
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. Please note that all boxes on the form need to be completed.
✉️ 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 using ordinary sentence case (not all capitals or lowercase). For a Windows device, use the free Adobe Online tool, or for a Mac device, use Preview.
Note: Only the first 2 pages of the form need to be completed; the last page must be dated and signed. Select the service(s) you want from the other pages.
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 send us an email to get our fax number.
- Please be sure all boxes are completed
- 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.
