Forms

Forms

Prior to your first session, the following paperwork needs to be completed and returned to Julie:

  1. Medical Nutrition History Questionnaire – download, complete and return before your first session
  2. Office Policy Information – download, read, and retain a copy for yourself
  3. Notice of Privacy Practices – download, read, and retain a copy for yourself
  4. Policy and Privacy Practice Acknowledgment – download, sign, date and return before your first session (after reading the Office Policy and Notice of Privacy Practices)

 

  • You can mail via postal service to :
    Julie Alles,RDN,LD,CLT
    227 Early Wyne Dr.
    Taylorsville, KY 40071

Other forms may be provided on an individual basis dependent upon the client’s specific needs (i.e. tests, food journal, instructional material, etc.).

If you choose to do LEAP/Mediator Release Testing for Food and Chemical Sensitivities then forms are provided along with instructions.

You may phone 580-716-0458 if you have any questions, or contact Julie via email: julie@juliealles.net.

 

Julie Alles, RDN,LD,CLT 
Certified Food Sensitivity Specialist
Integrative and Functional Nutritional Medicine

Specializing in Inflammatory and Gastrointestinal Disease