Enrollment Form Complete and submit online:
https://mntsurveys.
Three-Day Food Record Please complete an online three-day food record using: https://www.myfitnesspal.com/. Please bring your username and password to your visit so we can access your information.
Office Forms
1. HIPAA Notice – Please review our HIPAA Notice of Privacy Practices. You will be offered a copy when you come for your visit.
2. Acknowledgement of Receipt – Please click on this link: Acknowledgement of Receipt of HIPAA Notice of Privacy Practices. Please download, complete, and bring to your visit.
3. NCS Your Privacy & Permissions – Please click on this link: NCS Privacy & Permissions – Please download, complete, and bring to your visit.
4. Policies and Procedures Form – Please click on this link: Policies and Procedures. Please download, complete, and bring to your visit.
5. Medical Release Form – Please click on this link: Release of Information. Please download, complete, and bring to your visit.
1. Food Frequency Assessment
https://mntsurveys.
2. Medical and Health History (Profile 100)
https://mntsurveys.
3. Lifestyle and Eating Habits Survey (Profile 200)
https://mntsurveys.