Enrollment and Insurance

How to Enroll

Referral forms are available through the LifeHelp office or you can download and print the referral form from home. Referrals are as easy as having the referral form filled out by your physician and faxed to our office at (727) 820-7907. For more information or to enroll, please call our office at (727) 820-7910.

Physicians, please print this referral form and fill it out to refer a patient to our services. 

Insurance

Outpatient diabetes education programs are covered by most insurance plans. Authorizations are required for managed care plans. To assist us in coordinating payment, please complete the Coordination of Benefits form.

Our Forms

The following forms are to be completed and brought with you to your first LifeHelp appointment:

• Diabetes Knowledge Survey
• Medication Record
• Patient Consent Form
• Assessment Form (complete the applicable form as directed by the LifeHelp staff)
  • Diabetes Assessment Form
  • Medical Nutrition Therapy Assessment Form
  • Pregnancy Nutrition Assessment Form