Modo Bio registration page for Registered Dietitians and Nutritionists. Step 1 of 8 - About You 12% First Name:* Last Name:* Email:* Phone Number*State:*Please Select oneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code:* Date of Birth* MM slash DD slash YYYY What is your role?*Select all that are appropriate Registered Dietitian Nutritionist (RDN) Dietetics Technician Registered (DTR) Certified Clinical Nutritionist (CCN) Certified Nutrition Specialist (CNS) Licensed Nurtitionist (LN) Non-Licensed Nutritionist Other OtherYears of Experience* QualificationsClick + to add multiple State LicensesLicense State* Add RemoveLicense Number* Add RemoveLicense Expiration* Add RemoveDEA NumberAdd if applicable. Add RemoveNPI NumberAdd if applicable. Add RemoveAdditional CertificationsSeperate certitifcations by a comma. You may enter up to 5. Write below exactly how you would like your name to be displayed.Example: Parker Condit, MS, RDN Add Your EducationClick "Add" to add multiple Education/Degrees. College/University Name Degree Year of Graduation Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. What are your Specialties?*You may select up to 5 Bodybuilding Brain, Mental Health, Stress Reduction Celiacs Disease Cholesterol Management Chronic Fatgiue Clinical Dietitian Colitis Corporate Wellness Crohn's Disease Diabetes and Blood Sugar Management Digestive Issues Disordered Eating Eating Disorders Gastrointestinal Geriatric Health Coaching Myofascial Release Heart Health and Metabolic Syndrome Holistic Nutrition Hormone and Endocrine Hypertension Immune Support Irritable Bowel Syndrome Ketogenic Diet Low Carb Men's Health Mindful/Intuitive Eating Oncology Nutrition Paleo Diet PCOS Pediatrics Peri/Post-Menopausal Pre/Post Natal Paleo Diet Renal Issues Sleep, Energy, and Fatigue Sports Nutrition Stress Management Vegan Diet Vegetarian Diet Weight Management Women's Health Other Other Specialties Do you speak any additional languages?Select all that are appropriate Albanian Arabic Armenian Bengali Bulgarian Chinese Creole Croatian Czech Dutch Farsi French German Greek Gujarati Hebrew Hindi Hungarian Italian Japanese Khmer Korean Laotion Lithuanian Mongolian Persian Polish Portuguese Punjabi Romanian Russian Serbian Spanish Swahili Swedish Tagalog Taiwanese Turkish Ukranian Urdu Uyghur Vietnamese Other Other Languages spokenSpeciality PopulationsSelect all that are appropriate Actors Bariatric Beginners Bodybuilders Brides-to-be Cancer Survivors Dancers Disabled Law Enforcement LQBTQ+ Men Middle Aged Military Models Overweight/Obese Peri/Post-Menopausal Post-Rehab Pre/Post-Natal Rehab Runners Seniors Student Athletes Women Youth Other Other Speciality Populations Do you offer virtual training?* Yes No Do you want to offer virtual visits on Modo Bio's platform?* Yes No Do you want to recieve referrals for in-person clients from Modo Bio?* Yes No What is your physical location for training? Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Provider BioWhy did you get into this field? What is your general philosophy when it comes to health and fitness? Describe your ideal client. Anything else you would like potential clients to know. Website Instagram Facebook Twitter Tiktok Initial EvaluationPlease enter your standard ratePrice $$* Time XX min* One on One SessionPlease enter your standard ratePrice $$* Time XX min* Partner SessionPlease enter your standard ratePrice $$* Time XX min* Small Group SessionPlease enter your standard ratePrice $$* Time XX min* Virtual SessionPlease enter your standard ratePrice $$* Time XX min* Sliding Scale?* Yes No
