Finger Lakes Nutrition - Nutrition That Makes Sense
New Patient Introduction
Patient Name:
Date:
Chief Concerns:
Medications and/or Nutritional Supplements currently taking:
Dietary Intake for 2 days before appointment:
Breakfast:
Snacks:
Lunch:
Snacks:
Dinner:
Snacks:
Breakfast:
Snacks:
Lunch:
Snacks:
Dinner:
Snacks:
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