Healthcare Providers

MNT Referral Form

Referral Cheat Sheet

What To Know

Referrals for Nutrition Counseling

ALL Patients are required to have a referral from their prescribing healthcare provider. We know that it’s time-consuming working with patients, so we try to  make referring patients to a dietitian easy for you.

All you need to do is FAX us the patient’s referral. We will call the patient to schedule their appointment with our dietitians. If you would like us to contact you after they have scheduled, just let us know

If you have any questions, contact our office staff at 626-268-1353 or email us at info@healthymissionrd.com

Healthy Mission Dietitian is in network with most major insurance companies!

Each insurance plan is different, but most people can work with a dietitian with little to no out of pocket cost!

Medicare Referral Requirements

Please note that referrals for patients with Medicare plans have some additional stipulations:

  • Provider – Mediare referrals MUST be signed by an MD or DO. Medicare will not accept referrals from nurse practitioners of physician assistants
  • Diagnosis code – the referral must have a diagnosis code for diabetes or CKD Stage 3a, 3b, 4, or 5
  • New referral every year – patients are required to have a new referral each calendar year. We will contact you for a new referral each year

Referral Tearpads

Make referrals simple by ordering our handy referral tearpads for your office.