patient filling out new patient forms at office

Patient Registration Forms

Please contact us to schedule an appointment in one of our office locations or a virtual telehealth counseling visit or for more information about our programs.

Our mental health therapists, psychologists, psychiatrists and dietitian nutritionists work out of different offices and have different hours with appointments available between 7AM and 9PM Monday to Saturday. Our receptionists are available to schedule your mental health therapy counseling, nutrition counseling, nutrition testing, psychological evaluation or psychiatric medication management appointment from 8:00-5:00 Monday to Friday. If you call outside these hours please leave a message and our receptionist will give you a call back the next business day. We also offer an online calendar to schedule your own appointments with our licensed psychiatrist for medication management, DEXA precise body fat and bone density testing, weight loss coaching and micronutrient testing.

PDF Forms:

For patients coming into one of our office locations. Please fax or bring these forms to your appointment with you:

PDF Patient Registration Form

Download the patient registration form which includes a financial agreement and other authorizations as a PDF document. Fill it, print it and bring it with you the day of your appointment.

PDF Medical Release Form

If you would like us to send your documents to another provider or person please fill out this form and fax or email to us.

PDF For Medicare Patients

If you have Medicare please fill out this form and email to our office or bring it with you.

Online Forms:

For telehealth patients and patients visiting us at one of our office locations who prefer to fill forms out online.

Online Patient Registration Form

Fill out the patient registration form which includes a financial agreement and other authorizations and submit online to our receptionist.

Online Medical Release Form

If you would like us to send your documents to another provider or person please fill out this form and submit online to our receptionist.

For Medicare Patients

If you have Medicare please fill out this form and submit online to our receptionist.

Online Insurance Verification Form

If you would like us to check your insurance benefits including your deductible, number of visits covered and co – pay amounts please fill out this form and submit online.

Please contact us to schedule an appointment in one of our office locations or a virtual telehealth counseling visit or for more information about our programs.

Our mental health therapists, psychologists, psychiatrists and dietitian nutritionists work out of different offices and have different hours with appointments available between 7AM and 9PM Monday to Saturday. Our receptionists are available to schedule your mental health therapy counseling, nutrition counseling, nutrition testing, psychological evaluation or psychiatric medication management appointment from 8:00-5:00 Monday to Friday. If you call outside these hours please leave a message and our receptionist will give you a call back the next business day. We also offer an online calendar to schedule your own appointments with our licensed psychiatrist for medication management, DEXA precise body fat and bone density testing, weight loss coaching and micronutrient testing.

Telehealth Patient Appointments:

When you schedule your appointment our receptionist will ask you to send a picture of  your license and front and back of your insurance card before your appointment to info@washnutrition.com so we can verify your benefits. If your provider does not see these cards on file they will ask you to send them to our receptionist before the appointment.

In-Office Patient Appointments:

When you schedule your appointment our receptionist will ask you to send a picture of  your license and front and back of your insurance card before your appointment to info@washnutrition.com so we can verify your benefits. If your provider does not see these cards on file they will ask you to send them to our receptionist before the appointment or make copies at the appointment.

No Show Policy:

Please note we are a very busy practice and most of our providers are in demand with a patient waiting list so it is important to us that we stay on schedule so we do not keep our other patients waiting. Our appointments are schedule in 15, 30 or 60 minute slots depending on the type of service so if you are 15 minutes or more late to your appointment your provider may not be able to see you or at least will not be able to extend your appointment time. You will also be charged a no-show fee which is $100 for mental health therapy services and $100 for initial nutrition therapy and $50 for follow-up nutrition therapy visits. You can schedule another appointment within the next few days if your provider has availability or the following week. 

PDF Forms:

For patients coming into one of our office locations. Please fax or bring these forms to your appointment with you

PDF Patient Registration Form

Download the patient registration form which includes a financial agreement and other authorizations as a PDF document. Fill it, print it and bring it with you the day of your appointment.

PDF Medical Release Form

If you would like us to send your documents to another provider or person please fill out this form and fax or email to us.

PDF For Medicare Patients

If you have Medicare please fill out this form and email to our office or bring it with you.

Online Forms:

For telehealth patients and patients visiting us at one of our office locations who prefer to fill forms out online.

Online Patient Registration Form

Fill out the patient registration form which includes a financial agreement and other authorizations and submit online to our receptionist.

Online Medical Release Form

If you would like us to send your documents to another provider or person please fill out this form and submit online to our receptionist.

For Medicare Patients

If you have Medicare please fill out this form and submit online to our receptionist.

Online Insurance Verification Form

If you would like us to check your insurance benefits including your deductible, number of visits covered and co – pay amounts please fill out this form and submit online.

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