MD Offices: To refer your patients, fax the following forms to our office at: 210-735-1176.
1) Fill out and sign this REFERRAL FOR MNT 2016
2) Most recent patient Medical History and Physical Form/Office Note with Diagnosis codes
3) Most recent pertinent patient Laboratory Data
We will contact your patient within 24-hours of receiving your referral, during the work week. We will fax a progress note to your office after the initial appointment and after periodic follow-up appointments.
Linda primarily works with teens and adults.
MD referrals are welcome but not required, unless you have Aetna or Medicare insurance coverage. Your appointments will be educational, enjoyable and confidential. Each session will be personalized to your own individual health concerns, lifestyle, and nutritional needs. I will collaborate with you to develop short and long term goals and a personalized meal plan. Exercise and behavior changes will also be addressed.
It will be important that you are willing to make changes and follow our instructions for success. To test your readiness for change, read this article.
Since new behaviors must be repeated several times before they become a habit, regularly scheduled follow-up appointments over a six month period are encouraged to provide diet monitoring, continuing education and positive reinforcement.
On your first visit to m virtual office these documents will be reviewed. If referred by your physician, I may have already received your medical history, labs, medication list and referral.
- Food Diaries
- Listing of Medications, Vitamins and Nutritional supplements, Food Allergies or Intolerances
- Copy of Recent Blood Work, if available
- Doctor/PA/FNP Referral Form or Diet Recommendations – helpful but only required for Aetna and Medicare
- MD’s Medical History/Office Note with Diagnosis Codes–helpful but not required. You may be able to print these off of your physician’s patient portal. Or with your approval, we can have your MD’s office fax to us.
The initial telehealth appointment will last approximately 60-75 minutes. During this appointment we will…
- Verify your identity with your date of birth and photo ID.
- Ask for your verbal consent to provide medical nutrition therapy through telehealth.
- Complete a nutrition assessment
- Discuss ways to measure your body composition
- Determine your problem areas
- Develop short and long term goals
- Determine your calorie, protein and fluid needs
- Collaborate with you to develop an individualized meal plan
- Teach you the steps to follow for your particular diet success
- Provide detailed handouts
- Answer your questions
Follow-up telehealth appointments will last approximately 30-40 minutes. Be sure to have your electronic documents and food diaries available. During this time we will…
- Review your food diaries or email photos
- Discuss steps taken toward achieving your goals
- Review problem areas and set alternate goals
- Adjust the meal plan, if needed
- Answer your questions
- Praise your successes and bolster your weak areas
- Encourage you to plan positive reinforcement rewards
- Help you plan for diet relapses and other challenges
Please bring these forms with you to your first appointment.
After you have scheduled your initial appointment, it would be very helpful (not required) for you to fill out this Health and Nutrition History Form. These questions help you think through your issues and save us time during our initial session. If you prefer not to answer the questions in this format, don’t worry. We will discuss the questions in person at your session. The form works best if you fill it out in one sitting, so your computer does not go to sleep and delete your entered data. Click submit at the end of the form and it will be automatically sent to our email in box.
You will be asked to record a 3-4 day food diary before your initial appointment. Your diary can be in any format; app, photos or you may download and print the food diary form above and then scan in and email it. Please include what, when, and where you eat and drink. Amounts are not necessary at this stage.
This notice describes how protected health information about you may be used and disclosed. This policy is in force during all of your sessions with the dietitian. You may download this form if you choose. You do not need to send this form to us.
During the COVID-19 pandemic, these procedures will vary based on recommended guidelines. You will be asked to sign and send us this form if you are paying for services using your insurance coverage or if you want your nutrition counseling information released to other health care providers or family members, in order to coordinate your medical care. If you have been referred by a physician, you have already agreed to have the doctor and dietitian coordinate your care. In this case, a release will not be required. We will not release your private information to anyone, except your doctor or your parent if you are a minor, unless you agree that we do so.
If insurance does not cover your visit, payment may be made by credit, debit or HSA card, or personal check at the end of each appointment. Receipts will be generated and emailed to you after your payment.
Linda is a Provider for these Insurance Plans : All plans vary in nutrition coverage, so we will call the company to verify your benefits.
- BCBS Plans
- Humana Plans
- United Healthcare
- Aetna Plans-MD referral required
Medicare Plans (MD referral required)
- Traditional Medicare Part B (only covers Diabetes and Non-Dialysis Kidney Disease)
Even though you have health insurance and may have a physician’s referral, your insurance may not cover nutrition counseling for your particular diagnosis. To check your eligibility, we will call your doctor’s office to get your diagnosis codes (ICD 10) and we will ask you for your date of birth, member ID # and group # off of your insurance card. Your payment may include a co-payment or payment toward your deductible, as specified by the insurance company. If a copay or deductible payment is required, we will inform you before the appointment. You may want to check with your insurance provider or review your own particular insurance policy for more details.
Medicaid: Linda is not a Medicaid provider. If Medicaid is your primary insurance, you must seek the services of a contracted Medicaid provider, in order to be covered.
Weekend Appointments: I do not take weekend appointments.