Please Acknowledge The Following: It is our policy that you will be committing to a minimum of 3 months of care with your Registered Dietitian. Committment to 7 appointments is agreed on before scheduling the first appointment.
The cost of our services is transparent on the "Get Started" page of our website. Financial committment is agreed upon the first appointment. *
I have read the terms of our services, including billing and insurance questions*
Erin Falco RDN INC does NOT verify insurance benefits for patients' sessions. We may not participate in your insurance and/or the reason for the visit may not be covered.
Specialized testing may be recommended by your RD. It is your choice to decide if you would like to proceed with testing. Costs may vary and will NOT be covered by insurance.
Which statement best describes you/ your child? I have a specific condition and am looking for a functional medicine approach.
I am generally well, I am looking to optimize my health.
I am seeking an alternative approach for disordered eating. I am aware of the required commitment and monthly fee for this type of care.
How willing are you to do the following? (5 being the highest) Invest a minimum of 3 months of care or treatment
Adjust food choices and lifestyle habits:
Take vitamins/ minerals if necessary:
Have functional lab testing to guide your treatment and progress:
Do mind/body work including practicing stress reduction, or meeting with a counselor if your dietitian recommends it
What are you/ your child's health goals? Identify food allergies / sensivitites
Decrease stress / regulate mood
Improve ADD / ADHD, OCD, or PANS/ PANDAS
Overcome sensory challenges/selective eating/increase variety in diet
Improve relationship with food
Reduce pain / inflammation
Improve hypothyroidism, Hashimoto's, thyroid health
Lose weight / gain weight
Eating Disorder Treatment
Manage gut health, IBS or IBD conditions
Manage Diabetes / Prediabetes
Check off all conditions/ symptoms that apply: Neurological, behavior or speech challenges
Chronic pain / inflammation
Anxiety around food or selective eating
Skin conditions / issues (hives, ezcema, psorasis)
Abnormal thyroid function
Cardiovascular health (blood pressure, cholesterol, fatty liver).
Anxiety and/or depression
Hormonal issues (PCOS, endometriosis, infertility, etc.)
Poor immunity / chronic illness
Head Injury (TBI, seizures, concussion)
Mid-day crashes / cravings
Indigestion, bloat, constipation, diarrhea, etc.
Chronic fatigue / sleepyness
Please describe your top health concerns:
What have you or your child tried before?
What alternative approaches are you looking for?
If referred, please share who you were referred by:
Do you have insurance? If so, which provider?
Please fill out the information below and we will be in touch with you to start your journey! Which days work best for your call?
Which hours are best to contact you?
Submit Application
Thanks for your interest in becoming a patient!
We'll get back to you soon after reviewing your application.
