You will need to download and fill out the packet of Intake Forms (see the button on the right) in order for us to get your program started. I need to know a few key details so we can start to individualize your experience from the beginning. You may send in completed forms via fax, email or snail mail. If you have any questions or concerns about filling out these forms, please don’t hesitate to contact me and I will guide you through the process.
One of the most important things I will need from you are your most recent lab results.
To have these sent to me directly, please be sure to give your primary card doctor a filled out and signed copy of the Medical Information Release form which is included in the packet above or you can click here to download it by itself. If you have not had lab work done within the last 6 months, I may request certain labs be performed to help build your program with more clear direction.
Payment is due in full at time of service and one week prior to the start of any class. Please make checks out to Mondo Nutrition Inc. and mail to: PO Box 151373, San Rafael, CA 94915
If you prefer to pay with a credit card, debit card, health savings account debit card, or flex plan debit card, I can accept them in person via Square or a PayPal invoice can be generated for your convenience. There is a nominal processing fee for this service.
HIPAA and HITECH:
Please click here (HIPAA and HITECH) to access the rules, rights and regulations governing the use of your personal health information.