What should be in my intake packet before a new nutrition client's first session?

A complete intake packet for a new nutrition client contains seven things: a signed informed consent with a scope of practice statement, a financial policy that covers cancellations and no shows, a health history that includes medications and supplements, a release of information for the referring provider, a written record of your insurance verification call, a telehealth consent with an emergency contact and location, and the baseline measures you intend to repeat at follow up.

Everything else is optional. Those seven exist because each one answers a question somebody may ask you later: a client disputing a charge, a payer auditing a claim, a physician wanting to know what you told her patient, or you at the six month mark trying to prove the work changed something.

Build the packet once, in a form the client can complete before she arrives, and the first session stops being a paperwork session. That is the real return. You are not adding forms for their own sake. You are protecting the hour you already sold.

Informed consent and scope of practice statement

Consent is the document that says what you do and what you do not do. For a registered dietitian in private practice, the scope of practice statement is the part that earns its keep, because most new clients arrive with an idea of nutrition counseling shaped by whatever they last read.

Say plainly that you provide medical nutrition therapy and nutrition counseling, that you do not diagnose disease, do not prescribe or adjust medication, and do not replace her physician. Name what happens if something clinical surfaces: you refer, and you say so in writing.

Include the nature of the service, expected frequency, the client's right to end services at any time, and confidentiality with its limits. If you are a HIPAA covered entity because you bill electronically, your Notice of Privacy Practices belongs here too, with an acknowledgment line.

The eating disorder and weight language question

If your practice has a stated stance, put it in consent rather than discovering the mismatch in session four. A sentence such as "I do not prescribe calorie restriction for clients with an active eating disorder diagnosis and will coordinate with your treatment team" sets an expectation and documents a clinical boundary at the same time.

Keep reading: How much does it really cost me to deliver one hour of nutrition counseling?

Financial policy, no show terms and good faith estimates

The financial policy is a separate signature. Do not bury it inside consent, because if you ever need to enforce a late cancellation fee you want a distinct page with her name on it.

Cover these items:

• Your self pay rate for initial and follow up visits, stated in dollars.
• The cancellation window, usually 24 or 48 hours, and the fee that applies inside it.
• That insurance does not reimburse missed appointments and the fee is her responsibility.
• How you collect: card on file, invoice terms, payment at time of service.
• What happens to a claim that is denied after the visit, including whether she is responsible for the balance.
• Superbill practice if you are out of network: that you provide one, and that reimbursement is not guaranteed.

Then the No Surprises Act piece. Under federal rules effective since January 2022, uninsured and self pay clients are entitled to a good faith estimate of expected charges before scheduled care. For a counseling practice this is straightforward: give a written estimate covering the anticipated course of visits, not just the first one, and keep a copy in the file. An estimate for six visits at your stated rate is a normal, honest document. Note in the estimate that the number of sessions may change and that a revised estimate will follow if it does.

Health history, medications and supplement review

The history form is where new dietitians over collect. Ask for what will change your plan in the first four weeks and let the rest come out in conversation.

The load bearing fields:

• Medical diagnoses with approximate dates, especially diabetes, thyroid disease, PCOS, IBS or IBD, celiac, hypertension, dyslipidemia and any bariatric history.
• Current medications with dose and timing. Metformin timing, levothyroxine on an empty stomach, GLP-1 agonists and their dose escalation schedule, diuretics, SSRIs and their appetite effects.
• Every supplement with brand, dose and why she takes it. This is where interactions and megadoses hide.
• Allergies and intolerances, separated. Anaphylaxis and bloating are not the same constraint.
• Recent labs and the date drawn, plus whether she can obtain them.
• Weight history in her own words, and a direct question about past or present disordered eating.
• GI symptoms, sleep, alcohol and current physical activity.

Add a household and logistics block that most forms omit: who else eats these meals, who shops, who cooks, how many nights a week she is home for dinner, and her working hours. A plan that fails on Tuesday usually fails for one of those reasons and not for lack of intent.

Keep reading: Why do so many of my clients stop following the meal plan by the second week?

Release of information and referring provider contact

A signed release lets you write to the referring physician, request labs, and coordinate with a therapist or endocrinologist. Make it specific: name the provider or practice, name what may be disclosed, name the purpose, and give it an expiration date. A blanket permanent release is weaker practice and some clients will balk at it.

Collect the referring provider's fax or portal address at intake, not later. If your referral came with an order or a diagnosis code, keep that document in the file. For medical nutrition therapy claims, the diagnosis on your claim needs to be supported by something, and a referral letter naming the condition is the cleanest support you will get.

Insurance verification and benefit check record

Verification is not a form the client fills out. It is a note you make and keep. Call the payer, or check the portal, and write down what you were told.

Field	Why it matters
Plan type and network status	In network versus out of network changes the whole financial conversation.
Covered CPT codes	97802 initial, 97803 follow up, 97804 group, all billed in 15 minute units. Some plans also cover 99401 to 99404 preventive counseling.
Covered diagnosis codes	Many plans cover Z71.3 dietary counseling as preventive at 100 percent; others require a medical diagnosis such as E11.9.
Visit limit per calendar year	Tells you how to space follow ups and when self pay resumes.
Deductible, copay, coinsurance	Determines what she owes at the desk.
Preventive exemption	Whether nutrition counseling bypasses the deductible under ACA preventive services.
Referral or prior authorization required	A missing referral is the most common avoidable denial.
Telehealth coverage and required modifier	Place of service 02 or 10, and modifier 95 where the payer wants it.
Reference number, representative name, date	Your only leverage if the plan later says otherwise.

Always add the sentence payers use themselves: quotation of benefits is not a guarantee of payment. Then tell the client the same thing in writing, so a denial is a disappointment rather than a dispute.

See how NourishPlanner handles this for dietetics and nutrition counseling

Telehealth consent and emergency contact protocol

If any part of your practice is virtual, telehealth consent is separate. It should state the technology used, the limits of a video visit, what happens when the connection fails, and that she consents to receive care remotely.

Two fields matter more than the rest. First, her physical location at the time of each session, because licensure follows the client's location and a client who drove to see her sister in another state has moved you outside your license. Second, a local emergency contact and the address where she will be, so that if something acute happens you can direct help to a real place.

Write a short protocol for yourself and keep it with the packet: what you do if she discloses suicidal ideation, if she appears medically unstable, or if she disconnects and does not return. Deciding that in advance is much easier than deciding it at 4:52 on a Thursday.

Baseline assessment data you will need at follow up

Every measure you collect at intake should be one you plan to collect again. Otherwise it is trivia.

1. A usual intake record: a three day food and beverage log, or a 24 hour recall you take yourself in session.
2. The symptom or outcome she names as her reason for coming, scored zero to ten in her words.
3. Two or three behavior anchors you can count: breakfasts eaten, dinners cooked at home, days with a vegetable at lunch.
4. Objective data available to you: weight if clinically indicated and she consents, blood pressure, recent A1C, lipids, ferritin, vitamin D.
5. A readiness and confidence rating for the specific change you will start with.
6. Her stated schedule constraints, in hours, for the coming month.

Those behavior anchors are what your progress notes will lean on. "Client reports eating breakfast five of seven days, up from two" is documentation a payer understands and a client can feel. A weight change alone is neither.

Putting the packet to work

Send the whole packet at least 72 hours before the first visit, with the good faith estimate attached, and require completion before you confirm the appointment. That single rule converts most of your no show risk into a rescheduling problem you learn about in advance.

Then decide, before session one, which baseline anchors you will track and how she will report them. That is the point where intake stops being paperwork and becomes the plan. NourishPlanner takes the behavior anchors you set at intake, sends her week of meals on Sunday night, and gives you a light daily check in so that by Thursday you can see who is still eating breakfast and who quietly stopped. The forms protect the visit. The follow through is what makes the second one worth booking.