Appointment Request
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How would you like us to follow up with you?
*
Email
Phone
State in which you reside:
*
Briefly describe why you’re seeking nutrition counseling at this time for yourself or a loved one. Please include if you were referred to Eat With Knowledge by a healthcare professional.
*
We see clients consistently every week, usually the same day/time each week. Currently we have a waitlist for clients wanting a consistent appointment after 4:00pm. Would you like to join our practice now for a morning or early afternoon consistent appointments or would you like to be put on our waitlist for when an afternoon appointment becomes available? We will use the above information to match you with a dietitian or refer you out to another practice if we cannot match your availability.
*
Please check off to acknowledge that you have read about our nutrition counseling process and what to expect working together. Please note that our initial session is currently $285 and our follow-up sessions are currently $185. (https://eatwithknowledge.com/counseling)
*
Yes I have read and acknowledge the above policy
Please check off that you have seen our insurance policies and understand we do not accept insurance (https://eatwithknowledge.com/appointments-policies)
*
Yes I have read and acknowledge the above policy
How soon would you like to schedule your appointment?
*
Please Select
ASAP, I'd like the next available appointment
I would like an appointment within a few weeks
I'm just gathering information at this time
I need an afternoon or evening appointment and would like to be put on the waitlist
Thank you! Someone will be in touch with you within 72 business hours
Submit
Should be Empty: