Ready to Refer a Patient?


We Save You Time & Money with Our Nutrition Services

Our nutrition therapy services optimize patient outcomes and reduce your time spent on dietary counseling.

Save Time. Save Money. Save a Life.


If you are a medical practitioner or health professional and have a patient that you would like to refer to YourFide Dietitian, for nutrition counseling and/or therapy, please download and complete this Patient Referral form. You can then submit it to us via fax ((470) 239-1564). Thankyou

Please be sure to include patient demographics, clinical notes, and labs.

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    Contact us today to speak with a team member to explore how we can partner for better patient outcomes

    Referring Office Contact Information
    Referring Professional*

    Your Name*

    Phone Number*

    Email*
    Fax Number*

    (If you would like a confirmation of your patient’s appointment, please provide your fax number or secure email address)


    Patient Information
    Patient Name*

    Date of Birth*
    Did your client provide payment for this service? ( yes or no)*

    Symptoms & Diagnosis*

    (Please inform patient to bring copies of their recent lab reports with them to their appointment.)


    We see patients in two locations -via Tele-health and in-office Snellville GA .Once we have seen the patient, we will fax a copy of the nutrition assessment to you for continuity of care and communication. We thank you in advance for trusting your patients to our care.

    The Expert Nutritionist

    YourFide Registered Dietitian, is an expert in the use of food and nutrition to promote health and manage diseases.

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    We are a compassionate and affirming Registered Dietitian-Nutritionists, that is open to clients of all ages, races, sizes, gender identities, religions and ethnic groups. We approach each interaction with open-mindedness and a nonjudgmental attitude. We are committed to providing the highest level of nutrition care to our clients.

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