Patient Forms

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Patients, please complete and submit a health profile, consent to participate, coach contract and medical information release forms prior to your first appointment by either mail, fax or email. 

 

Mail: 9001 Summa Ave., Baton Rouge, LA, 70809
Fax #: 225-761-5890
Email: IdealProteinBR@ochsner.org


Enrollment Forms:

Health Profile - Assists in determining a client's health status, program qualifications and custom weight loss plan.

Consent Form - Informed Consent for participation in Ideal Protein Protocol.

Coach Contract - Agreement of program expectations to support your success.

Medical Release and Release of Medical Information - Allows us to obtain medical records and labs from your health care provider, which supports your safety and coordination of medical care. Allows your primary physician to authorize your use of Ideal Protein Protocol.

Weekly Forms:

Meal Journal  - Submit two days prior to your weekly appointment to allow Ideal Protein coach to customize your weight loss plan and offer support.

Order Form – Submit two days prior to your weekly appointment to allow Ideal Protein coach to prepare requested items for efficient processing at your clinic visit.