Health & Nutrition Assessment Questionnaire
To ensure the maximum benefit of Nutritional Therapy, it is important that your information is accurate and up-to-date. If you notice any changes to your health, begin taking new prescriptions, etc., please notify me as soon as possible. It is also your right as a client to access, update, or delete your records at any time. Though Nutritional Therapy Practitioners (NTPs) like myself are not HIPAA regulated entities, I am committed to protecting client privacy and uphold the privacy best practices and the policies laid out in the U.S. Standards for Privacy of Individually Identifiable Health Information. Please see the Disclaimer for further details.
Note: If any of the required fields are not applicable, simply type “N/A”.
Jen Fisher, NTP