Nutrition Consultation Intake Form

At MaxLove Project, we invest in hope. Together, we're kickstarting our own food revolution, one specifically for kids fighting cancer and life-threatening illnesses. An anticancer diet, in our view, can't stand in place of a standard treatment protocol. But it should be a complementary or integrative part of the standard protocol. An anticancer diet can help patients thrive during treatment, increase the efficacy of treatment, and maintain optimum health and wellbeing after treatment. This, we believe, is what all our kids need to build a great foundation for healthy survivorship. 

We are proud to offer full scholarships to families enrolled in our Fierce Foods Academy who are seeking further assistance with non-clinical supportive care nutrition support and dietary interventions. We work with amazing dietitians/nutritionists to help you achieve your dietary/lifestyle goals for your family as you face a life-threatening childhood illness, such as cancer.

We advocate for a therapeutic pathway that starts wherever you are and ends in the therapeutic zone that best fits your child's and family's needs. We believe in bio-individuality and an evidence-based approach to nutrition. This means that we all have different needs based on our unique genetic makeup, health conditions, and health goals. It also means that only good science will lead us on an educated path toward family wellness. The latest science suggests that an optimal anticancer diet will be nutrient dense, low-glycemic, and anti-inflammatory. What this means in practice will differ for different families, but it broadly means that we need to reduce our intake of refined carbohydrates and processed foods and increase our intake of whole foods, like nutrient dense vegetables, fish, meat and eggs. Depending on your therapeutic needs and starting point, our dietitians will work with your family to develop reasonable goals and strategies that aim to empower you in home to do all you can to thrive against the odds. 

Please use this form to apply for a Nutrition Consultation Scholarship with MaxLove Project. 

Parent/Caregiver Name *
Parent/Caregiver Name
Preferred Family Phone Number *
Preferred Family Phone Number
Family Home Address *
Family Home Address
http://
Tell us more about your family's food culture, preferences, opportunities and challenges.
Please tell us more about the outcomes you hope to see with dietary/lifestyle interventions.
Tell us a bit about your commitment to dietary and lifestyle changes, if you are just starting out and are unsure of change or if you are prepared to make further change for therapeutic benefit.
Dietitian Matching *
To help us match you with a dietitian, please choose the level of dietary intervention that you're pursuing.
I acknowledge that I am participating in an informal nutritional support group organized by the founders of MaxLove Project, a nonprofit organization. There is no financial obligation, nor any other requirements for participation. My participation is voluntary. I agree to be added to MaxLove Project's mailing list. I agree to hold MaxLove Project harmless and understand that the organization and it's representatives are not responsible for my choices or my child's treatment. I acknowledge that I am voluntarily participating in a support group and any tips, advice, or suggestions acquired therein are not to be construed as medical or treatment advice. I also understand that MaxLove Project has the right to include and exclude participants in this program at will. I acknowledge and, by checking YES below, I am communicating that I agree to the terms and conditions outlined in the acknowledgement statement.