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Session 2: Forms For New Clients, HIPAA, Credit Card Authorization, and Policies

Having the right forms to collect information about your new patient will keep you organized and legally protect your business. It is usually easy to find example templates of these forms by downloading them from other RD's websites and modifying them to fit your business needs.


Here are a few essential forms that will help you keep your appointments uniform, and will benefit both you and the client. It is helpful to have these blank forms uploaded on to your website so your clients have access them and print them at any time.  Let's get started:

1. Provide a questionnaire prior to your initial session.

Your questionnaire should have them identify problem areas and what they hope to achieve from working with you. Start with the basics on their current health, and include any additional questions that you would want to know about their habits or interests.  The more you know and are prepared about your client beforehand, the more engaging your session will be. 


STEP 1: Make a list of all the questions that would be beneficial to know ahead of time about your client.

STEP 2: Browse through other private practice RDs’ questionnaires on their websites and write down the questions you like off of their questionnaire.

STEP 3: Combine the two lists and edit anything unnecessary to make your custom questionnaire.

2. Client Policy Agreement

To help both you and your clients to be successful and form a respectable business relationship, have clients sign a form listing your business policies. You want to be treated with respect and compassion just as you will be for your client, so having them sign your policies from the beginning forms a solid foundation for your professional relationship. Your policies should discuss or include:

  • Insurance billing and payments - Include a sentence stating that they will be responsible for any claims unpaid by insurance. Also list your all forms of accepted payment methods, such as cash and credit card.
  • No show and cancellation fees - This is also where you will indicate the required notice for canceling an appointment. 
  • Secure sources for communication - Make sure they understand that information they send to you via email will not be secure unless it is encrypted, and that a phone call is always the best way to ensure security. If they submit information in a non-secure way as you have described in this section, indicate that they have waived their right to hold you liable for any sensitive information they may have submitted. This topic will be discussed again below in the HIPAA section.


Download and review these example client forms from INSPIRD Nutrition. Simply replace with your business name and full name.

Please keep in mind that these are examples of client forms. It is highly recommended that you review and modify these forms with legal help to ensure your private practice is adequately protected based on your needs.



Health Insurance Portability and Accountability Act (HIPAA) is a federally-mandated regulation designed to protect personal patient information stored in medical records. There are no hard and fast rules of HIPAA-compliance. It's about maintaining patient privacy and taking reasonable measures to protect it.

First, you must have your clients sign the following two forms:

  • Acknowledgement confirming receipt of privacy notice 
  • Release of information form to coordinate with your patient's other health care providers

These forms can also be sections included in your consent and general privacy policy forms (see #2 above).

Second, you need to ensure that your office setup is reasonably private such that others cannot hear your conversation during sessions.

And lastly, you have to ensure that any information and documents transferred to you (either in-person, email, or fax) has a process set up such that it is out of view from others who have not signed a Confidentiality Agreement with you. Again, never allow patient information to be sent via email, unless it is encrypted.  

  • Virtru is an email plugin that encrypts your emails

  • If you use G-Suite, you can take measures to set up HIPAA compliant email.


4. Confirmation emails

While this isn't necessarily a signed form, sending a confirmation email with the following information to your patients will:

  1. Ensure your patients have been sufficiently informed about your policies.
  2. Provide proof that you sent all of the appropriate information to your patient.

Your confirmation email can be saved as a template on your computer for you to reuse and should include a summary of the following: 

  1. A summarized cancellation policy
  2. Your contact information to reschedule
  3. Date, time and location of the appointment 

You can also attach the initial questionnaire and other necessary forms to this email if they have not already completed them. Consider having handouts ready to help them get started before your appointment, such as:

  • Meal plans
  • Snack lists
  • Proper portion sizes
  • Recipes
  • Grocery lists
  • Goal sheets and other educational material.

Consider other confirmation communication such as text messages or even phone calls for clients who do not check their computer or cell phone often. Do keep in mind that text messages are not considered HIPAA-compliant, so be mindful if you are texting any sensitive patient information.