Intake & patient forms

New Patient Intake Packet

Please complete the patient intake forms.  Clicking begin will take you to the first form, upon clicking submit, you will be taken to each form in succession until the packet is completed. 

Begin Intake

Individual Forms (PDF) to Print

 

New Patient Intake Form

Office Guidelines and Policies

Patient Authorization for Use Disclosure of Health Information

Advance Beneficiary Notice of Non-Coverage – Medicare

Advance Beneficiary Notice of Non-Coverage – Commercial

HIPAA Notice and Acknowledgement

 

Individual Forms Submit Online

 

New Patient Intake Form

Office Guidelines and Policies

Patient Authorization for Use Disclosure of Health Information

Advance Beneficiary Notice of Non-Coverage – Medicare

Advance Beneficiary Notice of Non-Coverage – Commercial

HIPAA Notice and Acknowledgement

 

QUESTIONS?

Jump over to my contact page and give me a call or submit your information via my form and I'll get back to you as soon as I can.

Start a telemedicine call with
Libby Hugo
Libby Hugo, RDN, CDE
1125 E. Polston Ave, Suite B
Post Falls, ID 83854

Phone: 208-640-4502
Fax: 208-777-7330
Email: nutrition@libbyhugo-rdn.com

Close Bitnami banner
Bitnami