Nutrition Counseling Services Agreement

306 Hwy 377, Suite F, Argyle, TX 76226  ·  (940) 464-9800  ·  RadiantNutrition.com

1. Description of Services

Radiant Nutrition provides individualized Medical Nutrition Therapy (MNT) and nutrition counseling services by licensed, registered dietitians (RD/LD). Services are provided in person at our Argyle, TX office or via HIPAA-compliant telehealth video session.

Your initial appointment is approximately two (2) hours and includes a comprehensive nutrition assessment, goal-setting, and your initial care plan. Follow-up appointments are typically 30–60 minutes and focus on monitoring progress and adjusting your plan as needed.

2. Insurance & Payment

Radiant Nutrition is in-network with many major insurance plans. It is the client's responsibility to verify benefits with their insurance carrier prior to the appointment. We will submit claims on your behalf; however, any balance not covered by insurance — including co-pays, deductibles, and non-covered services — is the client's responsibility and due at the time of service.

Returned checks are subject to a $35 processing fee. Balances unpaid after 60 days may be referred to a collection agency.

3. Cancellation & No-Show Policy

We respectfully request at least 24 hours' notice for cancellations or rescheduling. This allows us to offer your time slot to another client in need.

• Less than 24-hour cancellation: A $50 late cancellation fee may apply.
• No-show (missed appointment without notice): A $75 no-show fee applies and is not billable to insurance.
• After two consecutive no-shows, we reserve the right to require prepayment to hold future appointments.

4. Scope of Practice & Limitations

Our registered dietitians provide evidence-based nutrition counseling and Medical Nutrition Therapy. Nutrition services are not a substitute for medical care provided by a physician or other licensed healthcare provider. We do not diagnose medical conditions or prescribe medications.

We encourage open communication with your primary care provider and welcome collaboration with your healthcare team.

5. Confidentiality & HIPAA

Your health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). Radiant Nutrition will not disclose your protected health information (PHI) without your written authorization, except as required by law or for treatment, payment, and healthcare operations purposes.

A separate Notice of Privacy Practices will be provided at your first appointment or upon request.

6. Telehealth Services

Telehealth sessions are conducted via a HIPAA-compliant video platform. By scheduling a telehealth appointment, you consent to receiving services electronically and acknowledge that you are located in the state of Texas at the time of service.

• A stable internet connection is required. Technical difficulties on the client's end do not waive the late-cancellation policy.
• Telehealth is not appropriate for emergencies. If you are experiencing a medical emergency, call 911.

7. Photography & Testimonials

Radiant Nutrition may request your permission to use de-identified success stories or voluntary testimonials for marketing purposes. Your participation is always voluntary and may be withdrawn at any time in writing. We will never share identifiable information without your explicit written consent.

8. Client Responsibilities

• Provide accurate and complete health and dietary history.
• Notify your dietitian of any changes to your health status, medications, or supplements.
• Arrive on time (or log on promptly for telehealth) to make the most of your appointment.
• Communicate openly about barriers, challenges, and successes with your care plan.
• Pay all balances promptly per the payment policy above.

9. Termination of Services

Either party may terminate the counseling relationship at any time. If you choose to discontinue services, we encourage a final session to ensure a safe transition. Radiant Nutrition reserves the right to terminate services in cases of non-payment, disruptive behavior, or if continued services are no longer clinically appropriate, with advance notice whenever possible.

10. Agreement & Acknowledgment

By signing below, you acknowledge that you have read, understood, and agree to the terms of this Client Services Agreement. You consent to receive nutrition counseling services from Radiant Nutrition and agree to abide by the policies outlined above.