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NANCY LUM, RD, LDN 700 GEIPE ROAD, SUITE 203 CATONSVILLE, MARYLAND 21228 443-490-1240 Dr. Andrew Averbach, Dr. Kuldeep Singh or Dr. Isam Hamdallah has recommended that you make your initial appointment with Nancy Lum our Dietitian to receive the extensive Bariatric nutrition education as soon as possible. This program is specialized for their patients and is not available elsewhere. There are two locations where Nancy Lum can schedule appointments: 

700 Geipe Road Suite 203 Catonsville, MD 21228-4176 on Mondays (9:00 AM to 4:00 PM) Wednesdays (9:00 AM to 4:00 PM)

7625 Maple Lawn Blvd. Suite 145 Fulton, MD 20759 on Thursdays (9:00 AM to 4:00 PM) Other hours may be added as the need arises.

The fee for our program is $215.00*** and due in full at your first date of service. Please see note at end of this document for accepted methods of payment. This initial consultation/assessment fee includes: ●

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During the 1-hr initial consultation/assessment for surgery, the Dietitian will review patient’s current eating patterns and patient questionnaire/contact information sheets filled out prior to this appointment. Nutrition/lifestyle change recommendations will be provided for the patient to start on before the next appointment. The Dietitian will also schedule the patient for the comprehensive three hour Bariatric Nutrition education class and two hour pre-op vitamin education class. The initial assessment appointment note done by the Dietitian will count towards the first weight loss documentation note to meet the insurance requirement as needed. The 30-40 minute weight loss documentation classes once a month for insurance will be scheduled with the Dietitian as needed. (see supervised weight loss program sheet for instructions as these appointments have a separate fee of $15*** a month – aggregate fee for all months of weight loss documentation is due in full at your month 2 visit, month one is included with your initial consultation ) Nutrition education handouts and folders will be provided at the initial Bariatric nutrition education class, the pre-op vitamin class, and the Transition or post surgery nutrition class with the Dietitian. Information on vitamin, mineral, and protein supplements, including purchasing information, as well as pre-op tips for post surgery will be provided at the pre-op class with the Dietitian. The one month Post surgery two hour Transition Nutrition class, you must call our office with your surgery date to be scheduled for this class. After you have completed the program and have been cleared for surgery you have up to 90 days, from your surgery date, to schedule your post-operative transition class. After 90 days post-surgery, the standard fee for this transition class will apply. Review of food records at appointments. Phone/e-mail contact to have questions and concerns addressed before and after the surgery. Clearance letter to the Surgeons indicating the patient is ready for surgery.

All other follow up appointments will be a $45*** fee for a 30 minute session or $80*** fee for an hour session with the Dietitian due at the time of service.

The GI and Bariatric Nutrition Center LLC is a private nutrition consultation company. Rev. 5/19/2012, HN


If you want to follow the Dietitian for general weight loss instruction and have not decided on surgery. You may schedule a 30 minute session for $45*** fee or a one hour session for $80***. General weight loss instruction is different education than Bariatric nutrition education and will require much more individual counseling. These notes may be used toward the weight loss documentation if and when you decide to have surgery. We strongly recommend making an appointment with the Dietitian after surgery for the following; If you become pregnant, as the vitamin and some food recommendations will change. If you develop vitamin deficiencies for various reasons discussed in nutrition class prior to surgery. If you start to regain weight to help you get back on track with the lifestyle changes necessary for success. d. If you are having a hard time implementing the lifestyle changes. a. b. c.

PLEASE NOTE: We do not process insurance forms, so payment is expected, in full, at time of service. We reserve the right to refuse service until payment is received. We accept cash, checks, money orders, and MasterCard, or Visa. We do not accept post-dated checks. You will receive a copy of the receipt to submit to your insurance company (NOTE: We do not accept Medicare assignment, therefore our services are not reimbursable through Medicare. Please do not submit receipts to Medicare). There is no guarantee that the nutrition consultation will be covered. It may be helpful to get a referral from your primary care provider which states that you have to go out of network for nutrition services. Our bariatric services, required for surgical clearance, are good for up to one year (365 days) from your initial consultation with Nancy Lum. This policy is in place for patient protection to ensure that there are no issues post-operatively and to ensure that your insurance company will accept the clearance letter we provide. In order for Nancy to sign off that she has provided you with the necessary education we cannot extend the services past one year. At 12 months or greater it is necessary to re-establish you as a patient, as your medical history/ eating habits/ lifestyle / weight/ BMI, etc. have likely changed and it is very likely that education materials have changed as well. The information needs to be fresh in order for you to be successful in your weight loss post-surgery and to avoid weight regain. If you not have completed the program within 12 months of your initial consultation, you will be required to begin the program over, this includes: a 1-hour initial consultation, 3-hour bariatric nutrition education class and the 2-hour nutrition pre-op class. These services are required for your surgical clearance. Re-starting the program will be at your own expense, and at our current fee for services.

If you have any questions, or to schedule an appointment, please contact: Nancy Lum the owner of The GI and Bariatric Nutrition Center LLC. Leave a message on our voicemail only line by calling 443-490-1240, e-mail at nutritiontruth@gmail.com, or contacat us through our website: www.nutrition5.com 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.

*** ALL PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE ***

The GI and Bariatric Nutrition Center LLC is a private nutrition consultation company. Rev. 5/19/2012, HN

DIETITIAN FEE SHEET 2012 rev 5-19-2012  

All other follow up appointments will be a $45*** fee for a 30 minute session or $80*** fee for an hour session with the Dietitian due at th...