Mentor Private Practice

When I first started my practice I spent TONS of time getting the initial paperwork and handouts all in line. I was clueless on what I actually needed on these forms and how to go about making the “official” in my office.Today’s post I want to cover form, tips for creating ones for your private practice, and how to keep it all HIPAA compliant! I hope that after reading today’s blog post you have a few ideas and a great direction on how to create yours, or by pass, the head aches completely.

What forms do you really need?

  • Client registration form is the first one to really spend time building. On this form, you collect all the basic information about your client: name, gender, occupation, address, and contact information.I want you to also ask- how did you hear about us or who referred you. This will allow you to reach out to those people and place more to know about your marketing.

If you are taking insurance you will also want to collect all that information on this sheet too.

Office Policy/Cancelation Policy– this form needs to state clearly your policies in order to set clear boundaries with clients and have expectations up from. Also, with your cancellation policy make sure it is very black and white and have a place that patients have to acknowledge they read this form and sign it.


Intake Form/ health History/ Patient Questionnaire– this form can be really helpful to get back before you see your client so you can have a chance to plan and prep before they get there. Sadly- getting forms back before someone comes in is rare especially if you have paper forms

  • As you build this see what else is out there. Next time you go to your doctor’s office, massage therapist, chiropractor, etc see what they have you fill out.
  • Types of information you might want to include
    • What brings you in today?
    • What are you struggling with currently?
    • Have you experienced a recent change in appetite, weight, etc?
    • What medications do you currently take?
    • Please list (check off) all your current medical and psychological diagnosis.
    • List off your food allegories or intolerance
    • Are you physically active? If so, please tell me about it.
    • Please write out what you ate and drank yesterday.


Concent to Care/ Concent to Treat– this for is giving you the dietitian permission to treat the patient and that is something goes wrong they will not hold you liable. I call this form the CYA (Cover Your A@&) form. The top portion of the form needs to say what you will do in your sessions and then at the bottom have the client agree to the form.

Medical Record Release of Information – this form allows you to talk to other health care providers. You might be thinking what;s the purpose of this, and this price of paper is magical for marketing later on along with coordination care and doing your job as a dietitian.

HIPAA Policy– we all know we need to have this in place. Again, research what is out there and see what other office have made you sign in the past. You MUST have this form in place.

Optional Forms

  • Welcome Letter
  • Directions and Map to your office
  • What to expect in your initial session

Paper vs Electronic

Think about when you go to the doctor’s office and you have a book of paper to fill out, it can be annoying because if it feels like each form is asking the same stuff. Be mindful in your form creation to see if you can make them neat, clean and not duplicated. There isn’t a standard amount forms your need, and every practice is different.

When I started out and for a long time we have paper forms for when a client comes in. Keep in mind all paper forms MUST be stored in a locked cabinet in order to be HIPAA-Compliant.  If you are wanting to go high tech and use Google Forms make sure you are using their Google Business suite to be HIPAA compliant.



If you are feeling a bit freaked out and overwhelmed after reading this entire post… I got your back! inside iLiveWell Business Academy we actually have forms for you to purchase and upload your logo to them.



By Adrien Paczosa

Adrien Paczosa is a Registered and Licensed Dietitian practicing in Austin, Texas and the surrounding counties. Adrien is also a Certified Eating Disorders Registered Dietitian(CEDRD). Adrien began her path towards nutrition through her falling down. She has been a dancing since age 2 and in college was a Kilgore College Rangerette. During a practice, she took a fall and broke her foot, and that sparked the ideas of needing a new direction in her life. After graduating in 2003 from the University of Illinois – Chicago with a bachelor of science degree in Human Nutrition, Adrien began her career as a staff dietitian at the hospital in downtown Chicago. She was promoted to the hospital’s Director of Food Service and Nutrition and was responsible for all food preparation as well as patient nutritional care. While working at her clinical job, Adrien maintained her passion for movement by working as a personal trainer and nutrition coach in downtown Chicago. In 2006, Adrien returned to Texas to be close to family, friends, and warmer weather! She opened her private practice, I Live Well Nutritional Therapy in 2007 and has only continued to grown. To date, iLiveWell Nutrition Therapy has multiple locations, contracts with numerous corporations and treatment centers, and currently, five dietitians are employed under iLiveWell. “Creating better access to dietitians!” has been one of the driving forces of Adrien’s company.

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