Forms & Policies
Practice Policies
- Financial Policy [pdf]
- Notice of Privacy Practices [pdf]
Patient Forms
We encourage you to download and print the following forms and complete them before coming to our office. This will get you out of the waiting room and in to see the dietitian a lot quicker! You may either bring the forms with you to the first visit, or fax or e-mail them to us before your first visit.
- DMA Welcome Form [pdf]
- Before Coming to DMA Nutrition [pdf]
- Patient Registration Form [pdf]
- Patient Self Assessment Form [pdf]
- Electronic Nutirtion Log [xls]
- Electronic Nutirtion Log [pdf]
Insurance
We do accept insurance; currently we accept Medicare and Blue Cross and Blue Shield. However, not all insurance companies cover for nutritional counseling by a registered dietitian. Most insurance companies do cover nutritional counseling for diabetic self management, renal disease care, and some insurance cover for high cholesterol. However, it’s always a beneficial to call your individual insurance company and check. Here are few tips when calling your insurance company:
- Ask if you are covered for Medical Nutritional Therapy (MNT) provided by a registered dietitian in an outpatient setting. Do mention if you have new or pre-existing health condition.
- If you are covered be sure to ask; the limitations (by hours per year or by sessions) and the co pay amount.
- If you are not covered ask if there is something the dietitian can do to be covered by your particular health condition. (Some times all it takes to be covered is for me to call and register or to fill out a form.) For any questions about insurance please contact Dina at dina@dmanutrition.com.
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