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WE SPECIALIZE IN

Eating Disorder Recovery · Disordered Eating And Chronic Dieting · Body Image Concerns
Weight-Inclusive Medical Nutrition Therapy

*We do respond to every inquiry! If the return email address is incorrect, we are unable to respond. Additionally, if you do not see a response within 24 hours, please check your spam folder.

Name

First Name

Last Name

Pronouns (Optional)

Date of Birth

Phone

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State

(Please note we primarily see clients in Colorado, but also see clients in many other states on a case by case basis)

Location Preferred

(We have two offices in Colorado - in the Denver Metro area and in Northern Colorado. We also offer virtual services)

What insurance do you have?

Side By Side accepts Cigna, United HealthCare, Optum, Blue Cross Blue Shield and Aetna

Are you a new client or a returning client of SBSN?

How did you hear about SBSN?

Referred by

What kind of support are you seeking?

(please check all that apply)

Eating disorder/disordered eating recovery

Assessment for disordered eating

Family Based Treatment for Eating Disorders (Adolescents)

Management of a chronic condition (ex: diabetes) through a weight-inclusive approach

Recovery from chronic dieting

Body image work

Do you have a medical diagnosis from your doctor or therapist for which you are seeking services for? If so, what is the diagnosis?

Example answers: "I have a diagnosis of F 50.0 Anorexia Nervosa." "I do not have a diagnosis but I suspect I am struggling with Bulimia."

Do you have any other medical or mental health diagnoses that you would like to share?

(This helps us to place you with the best fit RD)

Availability

Please list the best days and times of the week that you are available for sessions.

How would you prefer us to contact you?

Additional Comments

Contact Us To Get Started

WE SPECIALIZE IN

Green states: co, va, ny, ma, tx, mi, az, ca, FL, ky, nc, il, ut, wa, wy, ga, ok, ak, dc, PA, ID, OR, OH

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PHONE (708) 717-7394

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