Use this form if you are a health care provider wanting to refer a patient to Nutrition Dynamix or if you have insurance that requires a doctor's referral. Medicare requires a referral. 

Note: A referral is not usually needed for insurance coverage. Self referrals are acceptable if you have proof of the diagnosis code (reason you are seeking nutrition counseling).

Use this form to guide you through the questions you will need to ask your insurance company to determine if nutrition counseling is covered under your plan.

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