Harmonic Nutrition and Wellness

 

 

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For New Clients

To get the most out of your initial session and so that we may provide the optimum program for you, please complete the forms that apply to you and bring them with you to your first appointment. Alternatively, you may complete these forms and fax or email them to us at 866-432-9202 | This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 

Pediatric Clients:

icon Peds Consent Release Authorization with HIPAA

icon Practice Policies

icon 3 Day Food Diary

icon Peds Physician Referral Form

 

Disordered Eating Clients:

icon New Client Intake Form DEP

 

Coaching Clients:

icon Coaching Practice Guidelines

icon New Client Coaching Form

icon Food & Mood Log

 

Food Sensitivities & Intolerances Clients:

icon Food Sensitivity Testing Form

icon Food Sensitvity Symptom Survey Form

 

Optional:

icon Credit Card Payment Info

Lesli was very calming, knowledgeable, and helpful in every way.  She gave me some great ideas and also helped me with health issue questions.  She is wonderful!”