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 cell phone number. We will text this number for scheduling.Format: (000) 000-0000.
State you live in*
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 on our FAQs page)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
Virtual onlyIn-person is my preference, but I'm open to virtual if neededIn-person onlyNo strong preference
We are in-network the following insurance:

- Aetna

- Blue Cross Blue Shield

- Cigna (not Cigna Connect plans)

- United Healthcare

- Medicare

Note for Medicare: A diagnosis of diabetes or chronic kidney disease is needed to be covered by Medicare Part B. We do not accept most Medicare Advantage plans (Part C), except for BCBS and UHC.

Note for Medicaid (ex: TennCare/BlueCare plans): We do not accept any Medicaid plans at this time.
In-network insurance (see list above)I have out-of-network insurance, so I'll be paying out-of-pocket (we accept credit/debit and FSA/HSA cards). Check out our services page for pricing.I'm paying out-of-pocket and only interested in reduced-fee nutrition appointments (offered in a pay-what-you-can format, $60-120)
AetnaBlue Cross Blue ShieldCigna (not Cigna Connect)Medicare (see note for medicare above)United HealthcareI have out-of-network insurance (any insurance not listed above) or I'm choosing not to use insurance. I understand that this means I'll pay for my appointments out-of-pocket as they occur.
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.
GoogleHealthcare providerHealth insurance companySocial mediaFriend/family memberOther
If you heard about us from a healthcare provider, please list their name here.
Is there anything else we should know about you?
Should be Empty:

We are in-network the following insurance: