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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 I would like you to provide specific information so I can best address your health concerns. The more information I have, the more that I can help you.

This is the information I would like you to provide:

1. Nutrition Intake Form 
Please print and complete.  Ideally I would like to receive the completed form several days before your appointment. Scan and email it to me. If you do not have access to a scanner, you can mail it to my office address listed below.

2. Chronological List Health Problems
If applicable, on a separate sheet of paper, please put together a chronological account of health problems, things that were ruled out, any treatments, and how you responded. This should include medications, supplements, diet and any other treatment modalities. Scan and email it to me. 

3. Eating Diary
Please print and keep track for 4-7 days and bring those sheets to the session.

4. Laboratory Test Results
Please bring a copy of your most recent labs, plus any earlier labs or special tests if you feel they are pertinent.

5. Nutrition Supplements
Please bring your supplement bottles.

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

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

Counseling Office Address

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.

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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