New Client Forms


 

Please complete and return to us the New Client Intake Forms at least 48-hours BEFORE your new client consultation. The Diet, Nutrition, and Lifestyle Journal will need to be completed over the course of 3-days, and should include at least one (1) weekend day (e.g., Saturday or Sunday). Follow these Instructions for downloading, saving, completing, eSigning and emailing the Intake, along with any other requested or required information. Our secure email address is records@janellkaplan.com

REQUIRED for Women {Download} New Client Intake Form for Female | PDF Form

REQUIRED for Men {Download} New Client Intake Form for Male | PDF Form

REQUIRED for Children/Adolescents {Download} New Client Intake Form for Child or Adolescent | PDF Form

REQUIRED for All {Download} Diet, Nutrition, and Lifestyle Journal | PDF Form

OPTIONAL {Download} Authorization for Release of Information Pursuant to HIPAA | PDF Form

Scroll down to e-sign these 4 required documents

REQUIRED for All {E-Sign} Terms of Service

REQUIRED for All {E-Sign} Informed Consent for Nutrition Coaching/Consulting

REQUIRED for All {E-Sign} Practice Policies

REQUIRED for All {E-Sign} HIPAA Email Consent


eSignatures


Terms of Service/Enrollment Agreement

 

Informed Consent for Nutrition Coaching/Consulting

 

Practice Policies

 

HIPAA Email Consent