Thank you for completing forms before your first visit!

It saves us time in the office, and we can get right to work on your nutritional assessment.

However, if desired, you may request copies of forms to complete when you are seen in the office.

For Clients

Forms you need for your visit

Medical Nutrition Therapy Clients

Please read:

HIPPA Notice of Privacy Practices

Please complete:

Coaching Clients

Please read:

HIPPA Notice of Privacy Practices

Please complete:

NourishMentor, LLC Policies, Registration, and Consent Form
Release of Information Form (if applicable)
Wheel of Nutritional Health (if desired)

Online Clients

To meet with Ruth online, use the secure link and code included in your appointment reminder. At your appointment time, she will meet you there.

You will also receive an email from NourishMentor with links to forms that you may sign online. If you prefer, you may print the appropriate forms indicated to the left, complete, and fax to 724-289-1891.

Forms Library

HIPPA Notice of Privacy Practices

Please review before signing the consent form.

NourishMentor, LLC Policies, Registration, and Consent Form

Please print, complete, and bring to your first visit.

Release of Information Form

If you would like Ruth to communicate with or send progress notes to another person or medical professional, please print, complete, and bring to your first visit.

Wheel of Nutritional Health

If you would like to complete this self-assessment tool, please print, complete, and bring to your first session.

Coaching Registration and Consent Form

If you are a wellness coaching client that is not covered by insurance, please print, complete, and bring to your first visit.

You do not need to complete the other consent form if you are a coaching client.

Follow-up Form

To help us focus on what is most helpful for you in your next session, please complete this form and either bring it with you to your appointment or email it to me.