Request an Appointment with Positive Nutrition
Please fill out the information in this form to help us match you with one of our dietitians. A team member will *reach out to you with options for scheduling and/or a referral for another clinician if they are unable to take new clients at this time. We typically respond to requests on Mondays and Fridays. Thank you for reaching out!

PLEASE NOTE: All the dietitians in the practice are currently able to take on new clients.

*we will reach out to every inquiry! If you did not receive a response via email it's sometimes because the emails go to your junk or spam folders. Please add hello@positive-nutrition.com to your address book to ensure you receive our response!
Sign in to Google to save your progress. Learn more
Please list your first and last name. *
Please list your phone number. *
What is your email address? *
What are you hoping to get out of working with a dietitian at Positive Nutrition? *
How did you find us? List name of referring provider if applicable or say google search, social media, podcast, etc.
Do you reside in the state of Utah? *
Approximately how often are you hoping to work with your dietitian? (this helps us gauge whether schedules will align) *
What is your ideal availability? (you can pick more than one) *
Required
Are you hoping to do your appointments in-person or via telehealth? (NOTE: Katie is currently only seeing clients virtually. Jen, Lauren, and Paige are able to do in-person or virtually)
Clear selection
Which insurance do you have? (NOTE: we are in-network with the following insurances but coverage varies from plan to plan and it is up to you to know your benefits. We will supply you with an insurance script you can use to call and confirm your benefits) *
Required
Who are you interested in working with? *
What is your age range? (some of the RDs work with adolescents and others do not) *
Is there anything else you'd like us to know?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Positive Nutrition. Report Abuse
Google Forms