Eat Well to Be Well

Kelly Scott - 330.550.3655

FORMS

Forms that need completed prior to appointment:


ALL FORMS NEED COMPLETED PRIOR TO YOUR APPOINTMENT AND FAXED OR EMAILED 2 DAYS PRIOR TO YOUR APPOINTMENT


Fax: (888) 482-5741    EMAIL: kellylscott@gmail.com



FORMS:

1. Food Log - Please log a minimum of 7 days. Please put your name on this form.

2. Initial Consultation Form


3. Insurance Guidance - The purpose of this is to give you guidance in negotiating the insurance process and ensure that our time together is covered by your insurance plan.


4. Most Recent Lab Work- Please have your Physician's office fax all recent blood work prior to your appointment.



**The fact that I am in in-network provider does not mean that your appointment will be covered.

**Be very specific when calling your insurance provider. You will need to ask exactly what is covered under your plan and if you need a specific diagnosis.





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