APPLY TO BECOME A CLIENT

STEP 1: APPLY TO BECOME A CLIENT

Please take a moment to complete this form to help determine if we're a good fit.

* Indicates required field

Name *

First

Last

WHERE ARE YOU FROM? (CITY/STATE) *

E-MAIL ADDRESS *

PHONE NUMBER *

Age *

How did you hear about Simply Nourished? *

If Other please specify: *

Are you seeking assessment for a chronic condition? *

Beyond your primary health concern, are you being treated for any other diseases or conditions? (select all that apply) *

Provide a list of medications and supplements you take. *

SELECT THE STATEMENT THAT MOST APPLIES TO YOU. *

What are your expectations for working with me? *

Please note any additional information or questions *

How would you like to work together? *

I consent and grant permission to Simply Nourished to perform tests, provide medical nutrition therapy, and dietary recommendations as indicated. *

I agree to receiving marketing and promotional materials *

Submit

*Consent statement: Please open and read prior to submitting application.

CONSENT STATEMENT

STEP 2: PURCHASE INITIAL CONSULTATION

Please note:

An Initial Consultation must first be purchased and completed to be eligible for follow-up session(s) (including packages) purchases.
To upgrade your laboratory test purchase and become an active client of Simply Nourished, be sure to also purchase an Initial Consultation.

PURCHASE SESSION

STEP 3: BOOK SESSION

Once you've completed the form above, use the link below to submit a request for your first session. I'll review your request and let you know if your session has been confirmed!

BOOK SESSION

Note: This appointment needs to be pre-paid within 48 business hours of scheduling to confirm and activate appointment. At that time, you will receive new client forms and can start uploading documents to your client profile in the practice platform.

INSURANCE
I do not accept insurance. As a functional medicine practitioner, I work with each client to discover the underlying mechanisms of imbalance and address the root causes of conditions with food-as-medicine approaches. Unfortunately, the standard medical model and insurance companies are not up to speed on advanced functional testing, medical nutrition therapy, and the use of nutritional supplements to aid in optimal outcomes. I practice both evidence-based and practice-based care without constraints of an insurance company. Thank you for understanding my positioning on this and valuing my work through Simply Nourished.

SERVICES

There are no refunds or exchanges on any services. Pre-paid services or packages will not be refunded.
Cancellations, reschedules and appointment time adjustments must be made 48-hours in advance for full reschedule/reimbursement.
Pre-paid sessions can only be used by the client who purchased the package. A client must use their pre-paid sessions in a timely manner not to exceed 12 months. If a client needs additional time to complete their sessions, it must be pre-approved.

CANCELLATION
I am willing to reschedule appointment with you due to sudden illness, emergency, personal/family need, etc. There is no fee if appointments are cancelled (written notice, email, or message via phone/practice platform) or rescheduled within at least a 48 hour notice. A $100 no-show fee is charged to clients that do not show or cancel (provide notice) within a 48-hr period prior to the appointment. This helps to keep you accountable and me able to serve other clients should your slot become vacant. Thank you for your understanding.

COORDINATION OF CARE
A coordination letter to a physician or other medical professional can be done at request of client to ensure understanding of interventions and coordination of client care. Issuing a coordination letter will be billed at $50 for 15-30 minutes of practitioner time.