Study on scope of practice/referral to RDs

[Guest guest]

Dear members,

I'm a PhD student in psychology, and I am conducting a study on scope of

practice in psychology as it pertains to health. This study has important

implications for understanding how psychologists refer clients to dietitians and

personal trainers, and as part of the study I would like dietitians to give me a

" baseline " for our measure of basic knowledge of diet.

Currently in psychology, there's been an emphasis on working with conditions

such as diabetes and obesity. But, psychology PhD training involves NO training

in those kinds of health conditions as part of core curriculum, and NO training

in dietary science. Thus, there is a big danger of psychologists practicing

outside their scope of competency (and within a dietitian's scope of practice)

in addressing these concerns. There has, as yet, been no research on how often

psychologists refer clients with eating/dietary/exercise concerns to

professionals such as RDs or trainers, or whether psychologists are attempting

to intervene in these areas themselves.

As part of this survey, psychologists will complete a short questionnaire on

nutrition/diet knowledge and referral practice. I would like to compare their

scores to experts in this area. The survey is online and would be short for

dietitians (5-10 minutes; a few demographics questions and the knowledge

questionnaire).

We expect to find that psychologists are not knowledgable about diet and

nutrition, and don't refer to dietitians as much as they should. If this is the

case, we intend to advocate for improved training in referrals to RDs and

inclusion of RDs in treatment planning, or complete dietitian training to be

completed by psychologists who intend to engage in clinical work with

populations with conditions like obesity and diabetes and directly intervene in

these areas.

If you are interested in participating, the survey can be found at:

https://UFL.qualtrics.com/SE/?SID=SV_2mX5IUQN9ABbmmg

*Dietitians may find the nutrition knowledge questionnaire quite simple, as this

measure was developed to be administered to laypersons as well as dietary

science professionals (Parmenter K and Wardle J. Development of a general

nutrition knowledge questionnaire for adults. European Journal of Clinical

Nutrition. 53, 1999, 298-308). Please respond to the items with what you think

is the best response for a completely average person.

Thank you,

Mike C. Parent

University of Florida

http://www.psych.ufl.edu/~parent/

[Guest guest]

Hi Mike,

I hate to tell you this! I don't see that this test measures nutrition

knowledge.

I had a lot of difficulty with the survey since my answer would have been

" none of the above " - such as how many servings of fruits and vegetables a

day. Most " health professionals " would recommend 9 or more. Thus, your

survey didn't give that option, and I don't think most RDs would consider just

5-6 servings a day adequate (2 fruits, 3 veggies? 3 fruits, 2 veggies?

That's not enough!) ;-)

Maybe instead of " I don't know " one answer could have been " other " or

" none of the above. "

Most of these questions have more than one " best " answer - it truly would

depend on the client history!

For example, the bread/sandwich questions - it would entirely depend on the

" kind " of bread and if the cheese was organic or processed. (Most bread

sold as " wholegrain " is truly just junk food that I would NOT recommend.)

Lowest fat grilled food? Does the pork chop have the fat still on it

(like my father used to love his pork chops) and is the ground turkey that cheap

stuff with all the turkey skin in it, or is it ground turkey breast? Too

many unknowns. (And, maybe the steak is my favorite steak, bison or

organic/wild elk steak.) ;-)

So, you see, because so much can be read into each question, I guarantee

even RDs won't answer the same!

In a message dated 6/15/2012 7:48:58 A.M. Mountain Daylight Time,

rd-usa writes:

_Study on scope of practice/referral to RDs _

(http://groups.yahoo.com/group/rd-usa/message/28555;_ylc=X3oDMTJzYWhlYjZsBF9TAzk\

3MzU5NzE1BGdycElkAzEwMDM1N

TQ3BGdycHNwSWQDMTcwNTA2MTIwOQRtc2dJZAMyODU1NQRzZWMDZG1zZwRzbGsDdm1zZwRzdGltZ

QMxMzM5NzY4MTMz)

Posted by: " Mike Parent " _parent.mike@... _

(mailto:parent.mike@...?Subject=

Re:%20Study%20on%20scope%20of%20practice/referral%20to%20RDs)

_parent.mike _ (http://profiles.yahoo.com/parent.mike)

Thu Jun 14, 2012 2:40 pm (PDT)

Dear members,

I'm a PhD student in psychology, and I am conducting a study on scope of

practice in psychology as it pertains to health. This study has important

implications for understanding how psychologists refer clients to dietitians

and personal trainers, and as part of the study I would like dietitians to

give me a " baseline " for our measure of basic knowledge of diet.

Currently in psychology, there's been an emphasis on working with

conditions such as diabetes and obesity. But, psychology PhD training involves

NO

training in those kinds of health conditions as part of core curriculum, and

NO training in dietary science. Thus, there is a big danger of

psychologists practicing outside their scope of competency (and within a

dietitian's

scope of practice) in addressing these concerns. There has, as yet, been no

research on how often psychologists refer clients with

eating/dietary/Currently in psychology, there's been an emphasis on working

with conditions

such as diabetes and obesity. But, psychology PhD training inv

As part of this survey, psychologists will complete a short questionnaire

on nutrition/diet knowledge and referral practice. I would like to compare

their scores to experts in this area. The survey is online and would be

short for dietitians (5-10 minutes; a few demographics questions and the

knowledge questionnaire)A

We expect to find that psychologists are not knowledgable about diet and

nutrition, and don't refer to dietitians as much as they should. If this is

the case, we intend to advocate for improved training in referrals to RDs

and inclusion of RDs in treatment planning, or complete dietitian training

to be completed by psychologists who intend to engage in clinical work with

populations with conditions like obesity and diabetes and directly

intervene in these areas.

If you are interested in participating, the survey can be found at:

_https://UFL.https://UFhttps://UFL.https://UFL.<WBRht_

(https://ufl.qualtrics.com/SE/?SID=SV_2mX5IUQN9ABbmmg)

*Dietitians may find the nutrition knowledge questionnaire quite simple,

as this measure was developed to be administered to laypersons as well as

dietary science professionals (Parmenter K and Wardle J. Development of a

general nutrition knowledge questionnaire for adults. European Journal of

Clinical Nutrition. 53, 1999, 298-308). Please respond to the items with what

you think is the best response for a completely average person.

Thank you,

Mike C. Parent

University of Florida

_http://www.psych.http://wwhttp://_ (http://www.psych.ufl.edu/~parent/)

Jan Patenaude, RD, CLT

Director of Medical Nutrition

Signet Diagnostic Corp.

Telecommuting Nationwide

(Mountain Time)

Fax:

DineRight4@...

Certified LEAP Therapist (CLT) and specialist in inflammation caused by

non-IgE food sensitivity - which causes IBS, migraine, fibromyalgia,

arthritis and more. Co-author of the Certified LEAP Therapist Training Course

-inexpensive CPE for the RD and learn how to use the Mediator Release Test

(MRT)

and implement the LEAP Diet Protocol.

Your email is important to me. If you send me an important email, and I

don't respond in 2 business days, PLEASE give me a call. Some weeks, I get

buried in email and I do not mean to ignore your email.

[Guest guest]

Hi Mike,

I hate to tell you this! I don't see that this test measures nutrition

knowledge.

I had a lot of difficulty with the survey since my answer would have been

" none of the above " - such as how many servings of fruits and vegetables a

day. Most " health professionals " would recommend 9 or more. Thus, your

survey didn't give that option, and I don't think most RDs would consider just

5-6 servings a day adequate (2 fruits, 3 veggies? 3 fruits, 2 veggies?

That's not enough!) ;-)

Maybe instead of " I don't know " one answer could have been " other " or

" none of the above. "

Most of these questions have more than one " best " answer - it truly would

depend on the client history!

For example, the bread/sandwich questions - it would entirely depend on the

" kind " of bread and if the cheese was organic or processed. (Most bread

sold as " wholegrain " is truly just junk food that I would NOT recommend.)

Lowest fat grilled food? Does the pork chop have the fat still on it

(like my father used to love his pork chops) and is the ground turkey that cheap

stuff with all the turkey skin in it, or is it ground turkey breast? Too

many unknowns. (And, maybe the steak is my favorite steak, bison or

organic/wild elk steak.) ;-)

So, you see, because so much can be read into each question, I guarantee

even RDs won't answer the same!

In a message dated 6/15/2012 7:48:58 A.M. Mountain Daylight Time,

rd-usa writes:

_Study on scope of practice/referral to RDs _

(http://groups.yahoo.com/group/rd-usa/message/28555;_ylc=X3oDMTJzYWhlYjZsBF9TAzk\

3MzU5NzE1BGdycElkAzEwMDM1N

TQ3BGdycHNwSWQDMTcwNTA2MTIwOQRtc2dJZAMyODU1NQRzZWMDZG1zZwRzbGsDdm1zZwRzdGltZ

QMxMzM5NzY4MTMz)

Posted by: " Mike Parent " _parent.mike@... _

(mailto:parent.mike@...?Subject=

Re:%20Study%20on%20scope%20of%20practice/referral%20to%20RDs)

_parent.mike _ (http://profiles.yahoo.com/parent.mike)

Thu Jun 14, 2012 2:40 pm (PDT)

Dear members,

I'm a PhD student in psychology, and I am conducting a study on scope of

practice in psychology as it pertains to health. This study has important

implications for understanding how psychologists refer clients to dietitians

and personal trainers, and as part of the study I would like dietitians to

give me a " baseline " for our measure of basic knowledge of diet.

Currently in psychology, there's been an emphasis on working with

conditions such as diabetes and obesity. But, psychology PhD training involves

NO

training in those kinds of health conditions as part of core curriculum, and

NO training in dietary science. Thus, there is a big danger of

psychologists practicing outside their scope of competency (and within a

dietitian's

scope of practice) in addressing these concerns. There has, as yet, been no

research on how often psychologists refer clients with

eating/dietary/Currently in psychology, there's been an emphasis on working

with conditions

such as diabetes and obesity. But, psychology PhD training inv

As part of this survey, psychologists will complete a short questionnaire

on nutrition/diet knowledge and referral practice. I would like to compare

their scores to experts in this area. The survey is online and would be

short for dietitians (5-10 minutes; a few demographics questions and the

knowledge questionnaire)A

We expect to find that psychologists are not knowledgable about diet and

nutrition, and don't refer to dietitians as much as they should. If this is

the case, we intend to advocate for improved training in referrals to RDs

and inclusion of RDs in treatment planning, or complete dietitian training

to be completed by psychologists who intend to engage in clinical work with

populations with conditions like obesity and diabetes and directly

intervene in these areas.

If you are interested in participating, the survey can be found at:

_https://UFL.https://UFhttps://UFL.https://UFL.<WBRht_

(https://ufl.qualtrics.com/SE/?SID=SV_2mX5IUQN9ABbmmg)

*Dietitians may find the nutrition knowledge questionnaire quite simple,

as this measure was developed to be administered to laypersons as well as

dietary science professionals (Parmenter K and Wardle J. Development of a

general nutrition knowledge questionnaire for adults. European Journal of

Clinical Nutrition. 53, 1999, 298-308). Please respond to the items with what

you think is the best response for a completely average person.

Thank you,

Mike C. Parent

University of Florida

_http://www.psych.http://wwhttp://_ (http://www.psych.ufl.edu/~parent/)

Jan Patenaude, RD, CLT

Director of Medical Nutrition

Signet Diagnostic Corp.

Telecommuting Nationwide

(Mountain Time)

Fax:

DineRight4@...

Certified LEAP Therapist (CLT) and specialist in inflammation caused by

non-IgE food sensitivity - which causes IBS, migraine, fibromyalgia,

arthritis and more. Co-author of the Certified LEAP Therapist Training Course

-inexpensive CPE for the RD and learn how to use the Mediator Release Test

(MRT)

and implement the LEAP Diet Protocol.

Your email is important to me. If you send me an important email, and I

don't respond in 2 business days, PLEASE give me a call. Some weeks, I get

buried in email and I do not mean to ignore your email.

[Guest guest]

Thanks for your feedback! This measure wasn't developed by our team, however,

but by the Wardle group mentioned in the posting. Unfortunately, it is the

*only* available measure of general diet knowledge that had been administered to

both professionals and laypersons. They'd administered it to a sample of 100+

dietetics students in the developmental study, so I'm wondering how they handled

concerns such as you mention below!

But, thanks for the feedback! If their instrument really isn't understandable to

dietitians as we'd assumed (given that the other group's samples seemed to

work), we may have to reexamine use of it in this study.

Thanks,

Mike

>

>

>

> Hi Mike,

>

> I hate to tell you this! I don't see that this test measures nutrition

> knowledge.

>

>

> I had a lot of difficulty with the survey since my answer would have been

> " none of the above " - such as how many servings of fruits and vegetables a

> day. Most " health professionals " would recommend 9 or more. Thus, your

> survey didn't give that option, and I don't think most RDs would consider

just

> 5-6 servings a day adequate (2 fruits, 3 veggies? 3 fruits, 2 veggies?

> That's not enough!) ;-)

>

> Maybe instead of " I don't know " one answer could have been " other " or

> " none of the above. "

>

> Most of these questions have more than one " best " answer - it truly would

> depend on the client history!

>

> For example, the bread/sandwich questions - it would entirely depend on the

> " kind " of bread and if the cheese was organic or processed. (Most bread

> sold as " wholegrain " is truly just junk food that I would NOT recommend.)

>

> Lowest fat grilled food? Does the pork chop have the fat still on it

> (like my father used to love his pork chops) and is the ground turkey that

cheap

> stuff with all the turkey skin in it, or is it ground turkey breast? Too

> many unknowns. (And, maybe the steak is my favorite steak, bison or

> organic/wild elk steak.) ;-)

>

> So, you see, because so much can be read into each question, I guarantee

> even RDs won't answer the same!

>

>

>

>

> In a message dated 6/15/2012 7:48:58 A.M. Mountain Daylight Time,

> rd-usa writes:

>

> _Study on scope of practice/referral to RDs _

>

(http://groups.yahoo.com/group/rd-usa/message/28555;_ylc=X3oDMTJzYWhlYjZsBF9TAzk\

3MzU5NzE1BGdycElkAzEwMDM1N

> TQ3BGdycHNwSWQDMTcwNTA2MTIwOQRtc2dJZAMyODU1NQRzZWMDZG1zZwRzbGsDdm1zZwRzdGltZ

> QMxMzM5NzY4MTMz)

> Posted by: " Mike Parent " _parent.mike@... _

> (mailto:parent.mike@...?Subject=

Re:%20Study%20on%20scope%20of%20practice/referral%20to%20RDs)

> _parent.mike _ (http://profiles.yahoo.com/parent.mike)

> Thu Jun 14, 2012 2:40 pm (PDT)

>

>

> Dear members,

>

> I'm a PhD student in psychology, and I am conducting a study on scope of

> practice in psychology as it pertains to health. This study has important

> implications for understanding how psychologists refer clients to dietitians

> and personal trainers, and as part of the study I would like dietitians to

> give me a " baseline " for our measure of basic knowledge of diet.

>

> Currently in psychology, there's been an emphasis on working with

> conditions such as diabetes and obesity. But, psychology PhD training

involves NO

> training in those kinds of health conditions as part of core curriculum, and

> NO training in dietary science. Thus, there is a big danger of

> psychologists practicing outside their scope of competency (and within a

dietitian's

> scope of practice) in addressing these concerns. There has, as yet, been no

> research on how often psychologists refer clients with

> eating/dietary/Currently in psychology, there's been an emphasis on working

with conditions

> such as diabetes and obesity. But, psychology PhD training inv

>

> As part of this survey, psychologists will complete a short questionnaire

> on nutrition/diet knowledge and referral practice. I would like to compare

> their scores to experts in this area. The survey is online and would be

> short for dietitians (5-10 minutes; a few demographics questions and the

> knowledge questionnaire)A

>

> We expect to find that psychologists are not knowledgable about diet and

> nutrition, and don't refer to dietitians as much as they should. If this is

> the case, we intend to advocate for improved training in referrals to RDs

> and inclusion of RDs in treatment planning, or complete dietitian training

> to be completed by psychologists who intend to engage in clinical work with

> populations with conditions like obesity and diabetes and directly

> intervene in these areas.

>

> If you are interested in participating, the survey can be found at:

> _https://UFL.https://UFhttps://UFL.https://UFL.<WBRht_

> (https://ufl.qualtrics.com/SE/?SID=SV_2mX5IUQN9ABbmmg)

>

> *Dietitians may find the nutrition knowledge questionnaire quite simple,

> as this measure was developed to be administered to laypersons as well as

> dietary science professionals (Parmenter K and Wardle J. Development of a

> general nutrition knowledge questionnaire for adults. European Journal of

> Clinical Nutrition. 53, 1999, 298-308). Please respond to the items with what

> you think is the best response for a completely average person.

>

> Thank you,

>

> Mike C. Parent

> University of Florida

> _http://www.psych.http://wwhttp://_ (http://www.psych.ufl.edu/~parent/)

>

>

>

>

> Jan Patenaude, RD, CLT

> Director of Medical Nutrition

> Signet Diagnostic Corp.

> Telecommuting Nationwide

> (Mountain Time)

> Fax:

> DineRight4@...

>

> Certified LEAP Therapist (CLT) and specialist in inflammation caused by

> non-IgE food sensitivity - which causes IBS, migraine, fibromyalgia,

> arthritis and more. Co-author of the Certified LEAP Therapist Training Course

> -inexpensive CPE for the RD and learn how to use the Mediator Release Test

(MRT)

> and implement the LEAP Diet Protocol.

>

> Your email is important to me. If you send me an important email, and I

> don't respond in 2 business days, PLEASE give me a call. Some weeks, I get

> buried in email and I do not mean to ignore your email.

>

>

[Guest guest]

Thanks for your feedback! This measure wasn't developed by our team, however,

but by the Wardle group mentioned in the posting. Unfortunately, it is the

*only* available measure of general diet knowledge that had been administered to

both professionals and laypersons. They'd administered it to a sample of 100+

dietetics students in the developmental study, so I'm wondering how they handled

concerns such as you mention below!

But, thanks for the feedback! If their instrument really isn't understandable to

dietitians as we'd assumed (given that the other group's samples seemed to

work), we may have to reexamine use of it in this study.

Thanks,

Mike

>

>

>

> Hi Mike,

>

> I hate to tell you this! I don't see that this test measures nutrition

> knowledge.

>

>

> I had a lot of difficulty with the survey since my answer would have been

> " none of the above " - such as how many servings of fruits and vegetables a

> day. Most " health professionals " would recommend 9 or more. Thus, your

> survey didn't give that option, and I don't think most RDs would consider

just

> 5-6 servings a day adequate (2 fruits, 3 veggies? 3 fruits, 2 veggies?

> That's not enough!) ;-)

>

> Maybe instead of " I don't know " one answer could have been " other " or

> " none of the above. "

>

> Most of these questions have more than one " best " answer - it truly would

> depend on the client history!

>

> For example, the bread/sandwich questions - it would entirely depend on the

> " kind " of bread and if the cheese was organic or processed. (Most bread

> sold as " wholegrain " is truly just junk food that I would NOT recommend.)

>

> Lowest fat grilled food? Does the pork chop have the fat still on it

> (like my father used to love his pork chops) and is the ground turkey that

cheap

> stuff with all the turkey skin in it, or is it ground turkey breast? Too

> many unknowns. (And, maybe the steak is my favorite steak, bison or

> organic/wild elk steak.) ;-)

>

> So, you see, because so much can be read into each question, I guarantee

> even RDs won't answer the same!

>

>

>

>

> In a message dated 6/15/2012 7:48:58 A.M. Mountain Daylight Time,

> rd-usa writes:

>

> _Study on scope of practice/referral to RDs _

>

(http://groups.yahoo.com/group/rd-usa/message/28555;_ylc=X3oDMTJzYWhlYjZsBF9TAzk\

3MzU5NzE1BGdycElkAzEwMDM1N

> TQ3BGdycHNwSWQDMTcwNTA2MTIwOQRtc2dJZAMyODU1NQRzZWMDZG1zZwRzbGsDdm1zZwRzdGltZ

> QMxMzM5NzY4MTMz)

> Posted by: " Mike Parent " _parent.mike@... _

> (mailto:parent.mike@...?Subject=

Re:%20Study%20on%20scope%20of%20practice/referral%20to%20RDs)

> _parent.mike _ (http://profiles.yahoo.com/parent.mike)

> Thu Jun 14, 2012 2:40 pm (PDT)

>

>

> Dear members,

>

> I'm a PhD student in psychology, and I am conducting a study on scope of

> practice in psychology as it pertains to health. This study has important

> implications for understanding how psychologists refer clients to dietitians

> and personal trainers, and as part of the study I would like dietitians to

> give me a " baseline " for our measure of basic knowledge of diet.

>

> Currently in psychology, there's been an emphasis on working with

> conditions such as diabetes and obesity. But, psychology PhD training

involves NO

> training in those kinds of health conditions as part of core curriculum, and

> NO training in dietary science. Thus, there is a big danger of

> psychologists practicing outside their scope of competency (and within a

dietitian's

> scope of practice) in addressing these concerns. There has, as yet, been no

> research on how often psychologists refer clients with

> eating/dietary/Currently in psychology, there's been an emphasis on working

with conditions

> such as diabetes and obesity. But, psychology PhD training inv

>

> As part of this survey, psychologists will complete a short questionnaire

> on nutrition/diet knowledge and referral practice. I would like to compare

> their scores to experts in this area. The survey is online and would be

> short for dietitians (5-10 minutes; a few demographics questions and the

> knowledge questionnaire)A

>

> We expect to find that psychologists are not knowledgable about diet and

> nutrition, and don't refer to dietitians as much as they should. If this is

> the case, we intend to advocate for improved training in referrals to RDs

> and inclusion of RDs in treatment planning, or complete dietitian training

> to be completed by psychologists who intend to engage in clinical work with

> populations with conditions like obesity and diabetes and directly

> intervene in these areas.

>

> If you are interested in participating, the survey can be found at:

> _https://UFL.https://UFhttps://UFL.https://UFL.<WBRht_

> (https://ufl.qualtrics.com/SE/?SID=SV_2mX5IUQN9ABbmmg)

>

> *Dietitians may find the nutrition knowledge questionnaire quite simple,

> as this measure was developed to be administered to laypersons as well as

> dietary science professionals (Parmenter K and Wardle J. Development of a

> general nutrition knowledge questionnaire for adults. European Journal of

> Clinical Nutrition. 53, 1999, 298-308). Please respond to the items with what

> you think is the best response for a completely average person.

>

> Thank you,

>

> Mike C. Parent

> University of Florida

> _http://www.psych.http://wwhttp://_ (http://www.psych.ufl.edu/~parent/)

>

>

>

>

> Jan Patenaude, RD, CLT

> Director of Medical Nutrition

> Signet Diagnostic Corp.

> Telecommuting Nationwide

> (Mountain Time)

> Fax:

> DineRight4@...

>

> Certified LEAP Therapist (CLT) and specialist in inflammation caused by

> non-IgE food sensitivity - which causes IBS, migraine, fibromyalgia,

> arthritis and more. Co-author of the Certified LEAP Therapist Training Course

> -inexpensive CPE for the RD and learn how to use the Mediator Release Test

(MRT)

> and implement the LEAP Diet Protocol.

>

> Your email is important to me. If you send me an important email, and I

> don't respond in 2 business days, PLEASE give me a call. Some weeks, I get

> buried in email and I do not mean to ignore your email.

>

>

[Guest guest]

Agreed - this survey was not designed by a dietitian The choices are vague

and really quite odd (grilled turkey - which part?). The author clearly likes

cheddar cheese. Also interesting is the reliance on whole grain crackers -

there are so many other whole grain foods out there! I do not think this survey

will be very reliable or have much validity - I suggest a re-design with the

help of a nutrition professional before putting it out there with the hopes of

getting accurate results. Everyone should be able to indicate that you should

eat more veggies and less salt - this is not rocket science! I suspect most

people will answer similarly on many questions just on common sense. However

other questions do not have a clear answer and really are irrelevant to the type

of nutrition knowledge and skills that true nutrition professionals possess.

Thank You,

Berry, MS, RD

Healdsburg District Hospital

Clinical Dietitian

(707)431-6426

[Guest guest]

Agreed - this survey was not designed by a dietitian The choices are vague

and really quite odd (grilled turkey - which part?). The author clearly likes

cheddar cheese. Also interesting is the reliance on whole grain crackers -

there are so many other whole grain foods out there! I do not think this survey

will be very reliable or have much validity - I suggest a re-design with the

help of a nutrition professional before putting it out there with the hopes of

getting accurate results. Everyone should be able to indicate that you should

eat more veggies and less salt - this is not rocket science! I suspect most

people will answer similarly on many questions just on common sense. However

other questions do not have a clear answer and really are irrelevant to the type

of nutrition knowledge and skills that true nutrition professionals possess.

Thank You,

Berry, MS, RD

Healdsburg District Hospital

Clinical Dietitian

(707)431-6426