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?
Check all that apply: 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/ your child tried before? What alternative approaches are you looking for? If you are ready to move forward, please fill out the information below and we will be in touch with you to start your journey!
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Thanks for your interest in becoming a patient! We'll get back to you soon after reviewing your application.