Intake Forms

Option 1: Download, print the forms, sign, and mail to: 
      Humlie Medical Nutrition Care
      2520 NE Norton Ct 
      McMinnville, Oregon, 97128

Option 2: E-mail Gabby@HumlieMedicalNutritionCare.com and request a copy mailed to your address. Complete and mail back to the address in option 1. 

Option 3: (Not recommended) Use appointment time to complete forms verbally. This is the default option if forms are not completed. 

Required Signature:

Consent for Services

Required Signature:

Statement of Financial Responsibility

Required Reading: (no signature required)

HIPPA Notice of Privacy Practices

Signature acknowledging the previous document: 

Receipt of Notice of Privacy Practices