Get Started with Nashville Nutrition Partners

Hi! We're so glad you found us. Please fill out the questions below so we can begin your intake process. We do our best to get back to you within 1 business day. If you have any issues with the form, please email us at hello@nnp.clinic and we'll be happy to help.

By submitting this form, you agree to receive scheduling text messages at the number you provided, and agree to our Terms & Conditions and Privacy Policy. Standard message and data rates apply. If you do not consent, you can email hello@nnp.clinic to complete your intake with us differently.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
State you live in*
Reason for working with a dietitian (select all that apply):*

General health & wellnessImproving relationship with food and/or bodyEating disorder recovery & supportDiabetesHeart healthPCOSGastrointestinal conditionsReproductive health (fertility, pregnancy, postpartum)Kidney diseaseThyroid conditionsNavigating weight concerns (We have a weight-neutral approach. Read more here: https://www.nashvillenutritionpartners.com/faqs)Other
If you mentioned a health condition you have, please provide more information here so we can match you with a dietitian based on your needs
If you have been diagnosed with an eating disorder, have you received treatment in the past? If yes, please describe
What are your appointment preferences? Note: all of our dietitians offer telehealth sessions; a few of our dietitians offer some in-person appointments at our Midtown location (210 25th Ave N)*

Virtual onlyIn-person is my preference, but I'm open to virtual if neededIn-person onlyNo strong preference
What payment method do you plan to use? We're in-network with Aetna, Blue Cross Blue Shield, Cigna (not Cigna Connect), Medicare (not Medicare Advantage plans) and United Healthcare.*

In-network insuranceI have out-of-network insurance, so I'll be paying out-of-pocket (we accept credit/debit and FSA/HSA cards). More info on pricing: https://www.nashvillenutritionpartners.com/servicesI'm only interested in reduced-fee nutrition appointments
If you have insurance, please check which one you have below. We're in-network with Aetna, Blue Cross Blue Shield, Cigna (not Cigna Connect), Medicare (not Medicare Advantage plans), and United Healthcare.*

AetnaBlue Cross Blue ShieldCigna (not Cigna Connect)Medicare (not Medicare Advantage; a diagnosis of diabetes or chronic kidney disease is needed to be covered by Medicare)United HealthcareI have an out-of-network insurance plan (e.g. Medicaid, Humana, etc.). I understand that this means I'll pay for my appointments out-of-pocket as they occur.I'm not using insurance for my nutrition appointments
Onboarding fee: NNP collects a nonrefundable $100 onboarding fee for all new clients. This fee goes towards costs incurred when establishing new patients, including reviewing all your intake paperwork, benefits verification, care coordination, and other 1st session prep. This fee is not covered by insurance and would be paid out-of-pocket.We don't want this to be a surprise for people, so we call a little extra attention to it now and ask that you agree to the fee before moving forward with scheduling.*

I agree to pay the onboarding feeI would like to request the fee be waived
If you are filling out this form for a minor or person under your legal guardianship, please provide: 1. Your name 2. Your email address and phone number 3. The minor's date of birth
If you are filling this out for another adult who you are not a legal guardian for, we will need their contact info to contact them directly.
How did you hear about us?*

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If you heard about us from a healthcare provider, please list their name here.
Is there anything else we should know about you?
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