Get in Touch let’s chat! Have a question? Ready to schedule? Please fill out the contact form & we’ll get back with you! New Client Inquiry FormPlease enable JavaScript in your browser to complete this form.Are you completing this form for someone else (ex: a child or minor under the age of 18)? *YesNoName of the person completing this form: *What is your relationship to the client? *Please select an optionParentLegal guardian (other than parent)ProviderOtherEmail (of parent or guardian) *Phone # (of parent or guardian) *Client's Name *FirstLastClient Date of Birth *Email *Phone #: *How do you prefer we reach out to you? *EmailTextPhone callIs there a specific dietitian you are interested in working with? *Open to any dietitianAmy WilliamsonAshley KyleNikki ShawnWhitney LongHayley Sanders (starting March 2023)Amy MathewI'm looking to work with a dietitian for (select all that apply): *Eating disorder recoveryDisordered eating / chronic dietingIntuitive EatingImproving my relationship with foodBody imageOther medical issue (ex: diabetes, IBS, heart disease, etc.)Weight loss (***as anti-diet dietitians, we do not set intentional weight loss goals or assist with weight loss diets)Do you plan to use health insurance coverage for your nutrition sessions? *YesNoWhich of the following health insurance plans do you currently have?Please select an option...BCBSUHCCignaAmbetterSanaPlease note we are NOT in-network with any other insurance companies at this time. How did you hear about us? *Please select an option...TherapistPhysician / Medical ProviderTreatment centerFriend/familyInsuranceInternet searchOtherProvider's name:Please share any additional information that might be helpful for us to know: *Submit
