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Last Name

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Are you currently struggling with an active eating disorder? *

Yes

No

I'm not sure

I am stepping down from a higher level of care

Are you currently working with a therapist regularly? *

Yes

No

I am looking for one

Note: We are only in-network with Aetna, BCBS PPO, and Cigna. If you have an out-of-network insurance, we can provide a superbill. Please select one: *

I have Aetna

I have Blue Cross Blue Shield PPO

I have Cigna

Out-of-Network

I do not plan to use insurance

If you plan to use your insurance, please fill out the form below.

*Full Name of Primary Policy Holder (If Different Than Above)

First Name

Last Name

*Date of Birth

Primary subscriber

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Are you willing to move away from weight loss and start focusing on your health? *

Although we hold A LOT of space for the desire to lose weight, the dietitians at Laura Iu Nutrition do NOT specialize in weight loss. Our goal is to help you find authentic health independent of whether or not your body changes. We want to help you learn how to feel good in the body you already have!

Yes I am ready! - I understand you will NOT put me on a weight loss plan

Not there yet, but ready to learn - I understand you will NOT put me on a weight loss plan

No - I am looking for a dietitian to help me lose weight