Medicare requires a doctor's referral to a dietitian for Medical Nutrition Therapy. Currently, diabetes and renal/kidney disease are the only disease states that are currently reimbursed by Medicare. Medicare provides 3 hours of nutrition counseling the first year and 2 hours the subsequent years. Additional hours may be requested by your physician if your treatment plan or condition changes. Please have your medical provider's office complete the below referral form. 

Referral Form for Medical Nutrition Therapy

Online Referral Form for Medical Nutrition Therapy

If you would like your medical provider to release your health information (chart notes, labs, reports) to the dietitian, complete the authorization form and provide it to your provider who should then fax the requested information to us.

Authorization for Disclosure of Health Information

HIPAA Notice