Department Nutrition Services Application

Thank you for your interest in RescueRD's workshops and presentations! Please fill out this short survey.

Once complete, the booking appointment page will show.

I look forward to learning more about your department so that I can create a customized nutrition solution!

If you have any trouble, email [email protected]. Information submitted in this form is confidential and only reviewed by Megan Lautz, MS, RD.

First Name *

Last Name *

Phone *

Email *

Title or Rank *

What department do you represent? *

How large is your department? (ex. 500 firefighters) *

What is your biggest challenge with your department's wellness? *

What is your budget for wellness services? *

Do you have specific questions or services in mind? *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Thank you for taking the time to fill out the application, click next to look for availability in the booking appointment page.