1st Appointment

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1. Download and complete the New Patient Forms below or here and 

Click here for New Patient Forms 

Attach the forms below.

2. A 3-day food journal for Ann to learn about your eating.    

 Click here for the journal.                                                

Record the time you ate or drank, what you ate or drank and how much you ate or drank. Include any symptoms and/or feelings you experience you want to share with Ann. The more you share, the more Ann gets to know you! Attach your 3-day journal below.

3. Your most recent lab results. Ann will want to see your labs for a comprehensive review.  If you have pre-diabetes or diabetes your hemoglobin A1c, your lipid profile if you have elevated cholesterol, and anything else that is of concern. Attach your labs below.

4. Your insurance card(s), the front and back. Attach your insurance cards below.

5. Your payment, if you have a copay, have to satisfy your deductible or will be paying for the visit.

6. Obtain a written referral from your physician that specifies your diagnosis with the billing code, called the ICD-10 code. This is a separate referral from the one your insurance may require to see a specialist. 

7. Please email to karencpva@gmail.com prior to the appointment:

• New Patient forms
• Food journal 
• Lab report
• insurance card (front + back)

If you have any questions or need the fax #, call the office at 631.324.1953

Cancellation Policy: If you need to cancel, please allow at least 24 hours in advance of your scheduled appointment.  Otherwise, you will be charged $150.00 for the visit.  Please be considerate and respectful of Ann's time.