Patient Referral
True Paleo Inc uses medical MNT to facilitate treatment of disease and trauma (Chapter 486, Part X, F.S. and Chapter 64B8-42 F.A.C.). All potential clients seeking treatment, who are already being advised by a physician for their condition, must submit a referral form. We hope you will entrust your care with our organization.
Please send the following referral form to your provider.
Before scheduling an appointment, please submit a referral form. Once we receive your request, we will contact you directly within 24-48 hours (M-F) to approve scheduling for consultation. If you have any questions, please contact True Paleo Inc.
What is required on the Referral Form?
Referring Office Contact Information
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Referring practitioner name
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Client name
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Practitioner phone number
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Practitioner fax number
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Practitioner responding email address
Patient Information
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Patient name
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Patient DOB
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Patient phone number
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Does the patient require the Client Assistance Fund?
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Proof of income
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Patient concerns
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Patient symptoms and/or diagnoses
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Diagnostic codes