ANRP Patient Questionnaire
A copy of your responses will automatically be emailed to the email address you provide in this form. Please confirm your email before you submit.
Welcome to the Achieve Nutrition Results Program (ANRP). Nancy Lum, RD, LDN, President/ Owner, has been practicing since 2001 and has been involved in multiple medical disciplines with a concentration in GI and Bariatric Nutrition since 2002. Nancy is currently seeing patients with multiple GI diagnoses, diabetic, cardiac, and general weight loss patients from various medical practitioner referrals and word of mouth. Nancy is also co-founder of STRIVE Motivational Group Therapy – est. 2012; which focuses on nutrition, lifestyle,
and behavior modification to get to the root cause of eating habits. Nancy is also co-founder of ANRP and Trilogy Transformational Coaching which work with general health and weight-loss.
Our mission is to greatly improve the quality of our patients’ lives by empowering patients through extensive cutting edge nutrition education and providing unique tools necessary for long term weight loss success and the reduction of medical co-morbid conditions. Our primary goal as nutrition experts is to build long term relationships with patients by educating, encouraging, supporting, and leading patients through the journey of permanent lifestyle change.
Our client expects to be treated with the utmost care and concern for their well-being and provided with a detailed and thorough education with access to long term follow up care. We look forward to assisting and advising you throughout the process of having surgical weight loss. The nutritional and lifestyle changes you will be making are of the utmost importance to your success with the procedure. We want to provide comprehensive nutrition education to ensure your success. We look forward to sharing our expertise and knowledge with you.
We do not participate with insurance companies, including Medicare. Payment is due, from the patient, in full, at the time of service/ enrollment. We reserve the right to refuse service if payment is not made at the time of service. Please see our attached “Financial Policy” for details on fees. Please read the paperwork attached prior to this appointment, and complete the attached questionnaire and forms. By signing you are agreeing to enter into a consultation agreement with The GI and Bariatric Nutrition Center and it's subsidiaries and understand your financial responsibilities to our office.
Nancy Lum, RD, LDN, President/Owner
Websites & Social Media:
Achieve Nutrition Results Program (non-bariatric nutrition services)
STRIVE MD Motivational Series (Cognitive Behavioral and Nutrition Therapy Groups
GIBNC (bariatric services)
Page 1 of 31
Never submit passwords through Google Forms.
This form was created inside of The GI and Bariatric Nutrition Center.