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.

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Please send the following referral form to your provider.

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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

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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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