PATIENT RESOURCES

PATIENT FORMS

NEW PATIENT FORM

Print and fill out this form if you are

a new patient.

MINOR CONSENT FORM

Print and fill out this form if your child will be seen.

TUBE FEEDING FORM

Patients and caretakers, please fill out prior to first appointment.

NUTRITION INTAKE FORM

Print and fill out this form if you are a new patient.

BARIATRIC INITIAL ASSESSMENT FORM

MEDICARE ABN FORM

HEALTH CURRENT SECURE INFORMATION

What you need to know about secure sharing of your health information.

HIPPA PRIVACY POLICY

You HIPPA Privacy Rules regarding how your medical records and personal information are protected.

NOURISHLY &
RECOVERY RECORD

EVERY AM Nutrition Services' patient have access to Nourishly and/or Recovery Record

FULLSCRIPT

AM Nutrition Services' Patients get a discount on Fullscript!

FOOD INTAKE LOG

Print and fill out this form to give your Dietitian a better understanding of your eating habits.

WELCOME VIDEOS

AM Nutrition Services' Patients get a discount on Fullscript!

INSURANCE

ARIZONA

Contracted provider with the following insurance carriers:

Aetna
AmBetter by HealthNet
Arizona Care Network/Bright Health/Medica
Arizona Complete Health/HN AHCCCS
Arizona Priority Care
Banner
Blue Cross Blue Shield and Advantage
Care 1st/One Care/Wellcare
Cigna
CMDP/DCS-CHP
Health Choice/Steward Health
HealthNet
Humana
ICP Preferred Service Provider/Par80
Magellan Complete Care
Medicare
Mercy Care Plans
Merritain, Ameriben, Gilsbar
Optum/Lifeprint
Oscar Health
UHC Community Plan (UHCCP)/Dual
United Health Care, UMR
Devoted Health

Accepts ALL out-of-network insurances with prior authorization including, but not limited to:

Bridgeway
SCAN

NEVADA

Contracted provider with the following insurance carriers:

Aetna
AmBetter
Anthem Blue Cross Blue Shield Nevada
Anthem Medicaid
Cigna
Culinary
Health Plan of Nevada/SHL only
Humana
Medicare Nevada
Molina Health Care
Nevada Medicaid
Prominence Health Plan
Sierra Health and Life
SilverSummit Healthplan
Teachers Health Trust Nevada/UMR
UMR
United Healthcare

PATIENT EDUCATION

SERVICES

MEDICAL NUTRITION THERAPY

An evidence-based medical approach to treating certain chronic conditions through the use of an individualized tailored nutrition plan administered by Registered Dietitians.

INDIVIDUALIZED NUTRITION PLAN

A plan developed to fit your daily routine based on your medical and nutritional needs.

MULTIDISCIPLINARY TEAM

We partner with your referring physician to provide the best care to help you live a better nutritional life.

ACCOUNTABILITY

We partner up with you to address your personal challenges and struggles to reach your nutritional goals.

We encourage sustainable, healthy and realistic behavioral changes that that supports a lasting change on your health. We educate, guide, and support you as you take baby steps in your journey to improving your health.

EATING DISORDER TREATMENT

We partner with you to help to sustain eating disorder recovery by determining the level of care needed by the patient, solidifying behaviors learned in the inpatient setting, and providing support in a less structured environment using intuitive eating and HAES approach to weight restoration and treatment of eating disorders.

DIABETES MANAGEMENT

Your daily routine can affect your blood sugar levels to rise and/or fall. We work with you to develop a personalized food plan that takes into account your eating preferences, schedule, and nutrition requirements to better equip you in managing blood sugar levels.

ANOTHER SERVICE?

Want to learn more or can't find what you're looking for? Please contact us for more information.