Jan Kincaid Rystrom, MEd, RD, CDE
360.734.2612

fax: 360.656.5835
email: jan@mixingbowlstudio.com

Mailing Address:
PO Box 31163
Bellingham, WA 98228-3163

  

 
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 
 
Forms

In cooking, it takes good ingredients to make a great dish. In our Studio, good information is the key ingredient. These forms will help to make the most of your visits to the studio.

If you have insurance coverage, you will need the Referral Form signed by your health provider. They can FAX it to us at least 3 days prior to your appointment at 360-656-5835.

Health History and Goals:
This provides us with the background we need to help create your plan for health. Be sure to include your personal goals.

Food Record:
It is important to know, and respect, your lifestyle. Please keep a record of at least 3 days of everything you eat and drink. Bring this to your first visit, or fax it in so we can review it before your first visit.