Forms

Insurance

Great news!! Your insurance plan may cover your nutrition consultation. NutriliciousbyZ is an in network provider with following insurance providers:

In addition to above listed insurance providers; we also provide discounted services for:

 

If you have any of the above insurance; please check with your insurance provider about the covered benefits with information on diagnosis code provided by your doctor.

Please provide a reference number or confirmation code while booking your first appointment with us. We will bill your insurance with the confirmation code. Please be aware that based on your plan copy / deductible may apply. In the event your claim is denied; you will be responsible to pay the consult fee in full. For more details feel free to refer to our financial policy or call us if you have questions.

If you don’t have any of the above insurance; we can provide you a super bill for the services provided on request which you can use to file a claim yourself.

For your convenience we accept all forms of payment including cash, check, PayPal, and all major credit cards.

Download and print the relevant form and email or fax forms to NutriliciousbyZ

New Patient forms

Other important forms: