Tina Thompson, MS, RD, LD
(859) 388-9152
535 W. 2nd Street
Suite 207
Lexington, KY 40508

info@bluegrassnutrition.net
HELPFUL FORMS

If you are a new client, please complete the following forms and bring them to your initial appointment.   


 New Client Initial Screening Form

Statement of Agreement

Notice of Privacy Practices

 Topics to Discuss

 3 Day Food Intake Form

 
 For New Eating Disorder Clients only


If you would like us to coordinate care with another provider (for example, your primary care physician), complete this form to authorize release of information:


 Authorization to Disclose Information Form

Signature Documentation Form


Note: To download Adobe Acrobat Reader for free, click here.


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