New Clients

Intake Forms

You will need Adobe Acrobat to view most of the forms below (except for Ying’s Health History and Psychotherapy Intake forms, and the Revisit form which are in word format).  You can fill them out here online by typing in the available fields, then print them out and bring them to us.  Or, you can simply print them out and fill them out by hand.  Please fill out the forms before coming to your first visit. If you have any questions about these forms, please contact us at Starkel Nutrition (Julie Starkel, Riana Giusti, Grace Lautman) at 206-853-0534 or Integrative Nourishment (Ying Yu, Grace Lautman) at 206-683-8753.

 

Forms for Julie Starkel, MS, MBA, RDN/CD, Riana Giusti, MS, CN and Grace Lautman, CPT at Starkel Nutrition

Julie and Riana now practice at Starkel Nutrition in the University District.  Please note that Grace is at both Starkel Nutrition and Integrative Nourishment.

INTAKE FORMS:

REVISIT FORM: (Only for returning clients – Please print this out and bring in with you)

 

Forms for Ying Yu, MS, LMHC, CN and Grace Lautman, CPT, LMHCA Candidate at Integrative Nourishment

INTAKE FORMS FOR NUTRITION COUNSELING:

NUTRITION REVISIT FORM: (Only for returning nutrition clients – Please print this out and bring in with you)

INTAKE FORMS FOR MENTAL HEALTH COUNSELING:

INTAKE FORMS FOR COUPLES COUNSELING:

Insurance Information

* Each individual practitioner at Starkel Nutrition or Integrative Nourishment accepts some health insurance plans (please see below). Each insurance company and plan is different. It is your responsibility to know the details of your plan, including whether the plan covers our providers for “nutrition”/ “nutritional counseling” or “mental health” if you’re seeing Ying for those services. Please consult with your individual insurance policy to verify your coverage so that you are aware of your responsibilities. As a courtesy to you, we will bill your insurance company for services at our clinic. You will be responsible for any co-pays due at the time of service, and you will be billed later for remaining balances due to deductibles or coinsurance.*

Here are some general questions you may want to ask your insurance provider in order to determine your coverage:

1) What is my “Out-of-Network” and “In-Network” coverage?

2) Do I need a PCP (Primary Care Physician) referral or pre-authorization to schedule appointments?

3) Do I have a deductible to cover?

4) How many sessions do I get per year?

5) What is my co-pay/coinsurance?

At Green Lake Nutrition we believe that everyone should have access to our services regardless of insurance coverage.  We offer a time of service discount for all non-insured patients. See our fee list at the bottom of this page for more information. Thank you!

 

*Julie Starkel at Starkel Nutrition accepts the following insurance payment for Nutritional Counseling:

  • Regence Blue Shield
  • Aetna
  • Group Health (Options, Alliant Plus, and Options PPO)
  • Group Health (Options Select, Alliant Select – requires authorization)
  • Cigna (some plans)
  • First Choice (some plans)
  • United Health Care
  • Uniform (for limited coverage
  • Premera (starting May 1, 2016)
  • Ask about smaller carriers…

*Riana Giusti at Starkel Nutrition accepts the following insurance payment for Nutritional Counseling:

  • Premera
  • Group Health (PPO)
  • Cigna
  • Aetna
  • First Choice
  • More coming

Ying Yu, MS, CN, LMHC accepts the following insurance payment:

For Nutritional Counseling

  • Regence
  • Premera / Lifewise
  • First Choice
  • Uniform
  • Aetna
  • Cigna
  • Group Health (Options, Alliant Plus, Options PPO)
  • Group Health (Options Select, Alliant Select – requires authorization)

For Mental Health Counseling:

  • Regence (will no longer take Regence after January 1, 2016)
  • First Choice
  • Uniform
  • Group Health
  • Aetna (Open Access plan only)

Services for Mental Health Counseling are often eligible for out-of-network coverage under certain health plans (such as Group Health, Aetna, Premera, and United Behavioral Health).

At this time, we do not accept Medicare or Medicaid as they do not have adequate coverage for nutrition nor mental health services.

Non-insurance Clients

We offer discounted out of pocket rates and various packages (which further reduce the rate per session) for clients without insurance coverage.  To see our fee schedule, download the link below.

 

*  Julie Starkel and Riana Giusti are located at Starkel Nutrition in the University District.