2024 Nutrition Inquiry Form | YMCA of Middle Tennessee

Nutrition Inquiry Form

Please complete the Nutrition Inquiry Form if you are interested in booking a Nutrition Consultation with our Registered Dietitian. Once submitted, the dietitian will reach out to complete the booking process.

First Name

Last Name

Phone Number

Preferred Contact Method

Phone Call

Text

I am a YMCA...

Member

Non-Member

Full-time employee

Part-time employee

Areas of Interest: Check all that apply

Enhance athletic performance

Healing Nutrition

Implement proper nutrition to support exercise routine

Manage disease risk

Weight Loss

Weight Gain

Accountability

Personalized meal plan

Practical health tips

If you selected "enhance athletic performance" as an area of interest, please indicate your sport

Please describe your Nutrition Goals

Which package are you interested in?

Personalized Nutrition Package: $200 (members) or $250 (non-members)

One 60-min Initial Nutrition Consultation / Two 30-min Follow-Up Appointments / Expires within 6 months

One 60-min Initial Consultation: $125 (members) or $150 (non-members)

Expires within 6 months

One 30-min Follow-Up Appointment: $60 (members) or $75 (non-members)

Expires within 6 months

Are you interested in scheduling a nutrition appointment with our dietitian?

Yes

Nutrition Appointment Availability and Preferences

Preferred appointment days

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred appointment times

9:00 a.m. - 1:00 p.m.

5:00 - 7:00 p.m.

For appointments, I would like to meet...

In-person (available at Green Hills, Brentwood and Franklin locations)

Virtual

Phone

Would you like to receive any information about our Nutrition Programs?

Active Older Adults (AOA) Lunch & Learns

After Breast Cancer (ABC) Program

Y Transform (only available at the Brentwood location)

Weight Loss Program