From determining your fees to setting up your initial client intake and getting paid, we’ve got it all in one place.

Use the forms we consistently rely on EVERYDAY in our own private practices and have been sharing with dietitians across the country.

We developed this toolkit for one reason - to help you streamline your business. If you don’t have the time to create these forms from scratch or spend hours upon hours searching for templates, you’ve come to the right place.

How It Works:

The Starter Toolkit can be instantly downloaded and includes 9 individual word documents that you can print right from your office and use immediately. These word documents use standard fonts (Century Gothic) and include placeholders for your logo when necessary.


Client Forms

Use these forms with all your clients (Spanish Versions Also Available!)

  1. Client contact information sheet

  2. 4-page lifestyle questionnaire that includes anthropometric information, health history, 3-day food journal, family and social information

  3. Medicare/Insurance Screening Form


  • HIPAA statement (from the Academy) and confirmation of receipt.

  • ABN form with instructions (from CMS)

Internal Business Forms

These forms will help determine if you’re charging enough for your services and streamline the insurance billing process.

  1. Excel spreadsheet to help you determine what to charge

  2. Invoice/Billing Statement to simplify insurance reimbursement

  3. Private Insurance Verification Form

  4. Medicare Insurance Verification Form



Physician Referral Forms

In order to provide medical nutrition therapy, you must receive a referral from a physician and follow specific protocols for ensuring your services can be reimbursed by insurance. Many physicians (and medical office staff) prefer faxed documentation even in today’s high-tech economy. These fillable forms not only make it easy for the physician, but keep you up to date with the latest billing codes.

  1. Diet prescription form and instructions for MNT referrals

  2. Fax and DSMT/MNT referral form

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