Register

Please complete and submit the form below. Print the page before submitting, if you wish to retain a physical record of the transaction.

Note: KetoDietCalculator is a tool for clinical nutritionists to use in designing ketogenic diets. After a diet has been created by the nutritionist, he or she can grant access to their patients or clients. There is no fee to use the program, but please consider an annual donation to support the maintenance of this program. https://www.charliefoundation.org

All fields are required unless noted.

First Name

Last Name

Email Address

Phone Number

Medical Institution

Profession/Job Title

License or Academy of Nutrition & Dietetics Number

Address Line 1

Address Line 2 (optional)

City

State/Province

Zip/Postal Code

Country

I accept the Terms of Service and Privacy Policy

I agree to the Business Associate Agreement