Please complete these forms PRIOR to your first visit.

 

With my training and background I practice under the CT CHAPTER 384b DIETITIAN-NUTRITIONISTS  Sec. 20-206t Excerpt; "Nutrition assessment" means the evaluation of the nutrition needs of individuals based upon biochemical, physical, and dietary data to determine nutrient needs and recommend appropriate nutrition intake including the establishment of priorities, goals, and objectives that meet nutrition needs; the provision of nutrition counseling in health and disease; the development, implementation and management of nutrition care plans; and the evaluation and maintenance of appropriate standards of quality in food and nutrition.

 

Sec. 20-206t. Construction of chapter. Nothing in sections 20-206m to 20-206s, inclusive, shall be construed as prohibiting the activities of: (1) Any person who does not hold himself out to be a Connecticut certified dietitiannutritionist, Connecticut certified dietitian or Connecticut certified nutritionist from engaging in dietetics or nutrition practice; (2) a person who does not hold himself out to be a Connecticut certified dietitian or Connecticut certified nutritionist from marketing or distributing food, food products or dietary supplements, from engaging in the explanation of the use, benefits or preparation of such products, from furnishing nutrition information related to any such products, or from the dissemination of information or literature related to any such products; (3) a person who does not hold himself out to be a Connecticut certified dietitian or Connecticut certified nutritionist from providing weight control services; (4) a person licensed or certified in this state under any other law from engaging in the profession or occupation for which such person is licensed or certified, provided such person does not hold himself out as being certified as a dietitian or nutritionist; (5) a person employed as a nutritionist by the government of the United States, or by the Special Supplemental Food Program for Women, Infants, and Children, if such person works solely under the direction and control of the organization by which such person is employed; (6) a student enrolled in an accredited academic program leading to certification, provided such student is clearly identified by a title which indicates his status as a student; or (7) a person registered as a diet technician by the Commission on Dietetic Registration under the supervision of a Connecticut certified dietitian-nutritionist in an institution as defined under section 19a-490.

 

NUTRITION INTAKE

 

 

DISCLOSURE OF TRAINING

 

 

DRUG-FREE-CARE

 

 

SYMPTOM SURVEY

 

 

MASSAGE INTAKE

 

 

LIGHT RELEASE