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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

  • Referring practitioner name

  • Client name

  • Practitioner phone number

  • Practitioner fax number

  • Practitioner responding email address

Patient Information

  • Patient name

  • Patient DOB

  • Patient phone number

  • Does the patient require the Client Assistance Fund?

    • Proof of income​

  • Patient concerns

  • Patient symptoms and/or diagnoses

  • Diagnostic codes

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