You are registering for SHARE the Health Nutrition Counseling

Registration Form created by SHARE Project

Please complete the information below! Our Registered Dietitian, Bekah, will reach out to you within 1 week to schedule your first appointment!

SHARE the Health Nutrition Counseling is an individualized program that is free to Project SHARE clients. Our Registered Dietitian will provide education, accountability, and support to help you improve your health and nutrition in a 30-60 minute session scheduled at your convenience!

Name *

Age *

Email Address *

Please re-enter the Email Address *

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Phone Number

Why are you interested in Nutrition Counseling Services? *

Are you currently experiencing any health concerns?

Please list any dietary restrictions/allergies/dislikes. *

Please list your weekly availability for a 30-60 minute meeting

Comments/Other

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