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. Our admin team is off on Fridays, so there may be a delay. If you have any issues with the form, please email us at hello@nnp.clinic and we'll be happy to help.

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

Reason for working with a dietitian (select all that apply):

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)

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, and a referral from your doctor, are required for coverage with 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.

What payment method do you plan to use?

Please check which insurance you have below.

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.

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?

If you heard about us from a healthcare provider, please list their name here.

Is there anything else we should know about you?

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.