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Welcome to the Practice/ Intake Forms

Dear Client,

You’ve made an appointment to see me and I look forward to working with you.

Prior to your appointment (at least several days before your appointment) I would like you to provide specific information so I can best address your health concerns.

Complete and email to me.

1. Nutrition Intake Form – Fillable PDF or Printable PDF.
(If you need more room to explain your health issues and treatments, add an additional separate word document.)

2. Eating Diary  –  Fillable PDF or  Printable PDF.
Keep track for 4-7 days.

3. Most Recent Laboratory Test Results
Email a copy.

4. Credit Card Authorization Form – Fillable PDF or Printable PDF 

I look forward to getting the materials soon and working with you.

Janet Zarowitz, MS, RD, CDN
Integrative and Functional Nutritionist


Telehealth Link  – virtual office 

In-person Counseling Office

Janet Zarowitz, MS, RD, CDN
141 North State Road
Briarcliff Manor, NY 10510

Phone: 914-222-3919

Office is in shared suite with Liza Margulies, LCSW.
Enter building under the Red awning.
Take elevator or stairs up one flight.
Parking and entrance are in rear of building, off of Old Saw Mill River Road (not off North State Road).
See map below.


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Cancellation Policy

I understand that things do come up and you may have to cancel an appointment.

As a courtesy to my practice I request that you notify me via email at least 24 hours before your appointment if your need to reschedule.

–Janet Zarowitz, MS, RD, CDN

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