NOTE: Before completing the form, make sure you have completed the Eating Attitudes Test from the 'Optimal Health + Nutrition' page, and your results showed no signs of an Eating Disorder. You will need to provide a copy of your results at a later date.

Please complete the form to determine your eligibility for nutrition services through your health insurance.

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If we find that you are eligible for nutrition services, we will contact you via email with further instructions prior to starting our nutrition program.