Get in Touch with Our Team

If you are looking to inquire to work with our team, please fill out the form below to provide us with some preliminary information. From there, you’ll receive an email from our team on your next steps. If you are a clinician, please fill out the clinician inquiry form here.

Note: we do not see weight loss clients at our practice.

Name

First Name

Last Name

Email

Date of Birth

MM

DD

YYYY

What prompted you to reach out?

If selected other in the question above, please specify.

What service(s) are you interested in?

Insurance based nutrition counseling

Out of pocket nutrition counseling

Out of pocket virtual meal support group

Out of pocket virtual individual meal support sessions

Can you explain more about what service you are interested in and why.

Phone

(###)

###

####

Referral Source:

Do you have insurance?

Yes

No

Insurance Provider:

If answered no above, please choose N/A

If answered other, please state your insurance carrier:

Do you have a treatment team?

Yes

No

When would you like to start treatment?

Where are you located?

Please make note that Courtney is currently not accepting new clients.**