Terms of Service

Nutrition, LLC

Rebekah DeWitt, MS, RDN, LD

You have just taken a very positive step in deciding to seek dietary and lifestyle changes. I am happy that you have selected me to guide you on this journey and I want you to feel comfortable with the consultation process. To accomplish this, I have prepared this introduction.

I have 3 years of experience as a registered dietitian. My education accomplishments include a bachelor’s of science in nutrition and dietetics and a master’s of science in nutrition and dietetics. I have previously worked with a cardiovascular clinic, created a weight loss program for clients of the Alabama Pain Center as well as clients of Alabama Bariatrics and Minimally Invasive Surgery, and taught undergraduate nutrition courses for Oakwood University. In addition, I have served as secretary for the North Alabama Dietetic Association and State Policy Representative for the Alabama Dietetic Association. My vision in this client-dietitian relationship is to assist you as far as it is in my ability to accomplish your health goals.

Although this document can seem long and complex, it is very important that you read it carefully and complete all sections before our first session. We can discuss any questions you may have at that time. Please continue to ask any questions or voice concerns throughout the course of treatment so that our professional relationship will be open and satisfying for all. When you sign this document, it will also represent an agreement between us. You may revoke this Agreement in writing at any time.

Appointments

Initial nutrition appointments are 50 minutes in duration, and follow up appointments are 30 minutes. After your intake appointment, future appointments will be scheduled. I see clients by appointment only. To change or cancel an appointment, I require at least a 48-business hour notice for any cancellations. This will help me to schedule those waiting for appointments and for you to avoid being charged for the time that was reserved for you. Clients who cancel without a 48-hour notice or do not attend their appointment will incur a cancellation/no show fee. If your appointment is on a Monday, and you leave a message on the machine over the weekend, that does not constitute 48-hour notice. No exceptions will be made for emergency situations. Insurance does not pay for late cancellations or missed appointments.

Adult Intake Packet for Nutrition Services 2

Emergencies

If you experience an emergency during or after hours, you should seek immediate help by calling 911, Helpline (539-1000 or 539-3424), your primary care physician, or one of the hospital emergency rooms for assistance as needed.

Financial Agreement

My policy is full payment at the time services are rendered. I accept cash, checks, and credit cards. I do not accept health savings or flex spending cards. I do not bill for insurance. I can provide a super bill receipt with my provider information which you may be able to submit for reimbursement depending on your insurance policy. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court which will require the