AIA Vitality Booking Enquiry

Please complete your details on the form and we will get in touch to answer your questions and let you know who the right consultant is to meet with.

Name

First Name

Last Name

Email address

Phone number

Age group

AIA Vitality Number

Please enter your membership number here.

What are the main things you would like to see one of our team about?

Please let us know what health issues or challenges you are seeking support for and what you would like to achieve by working with one of our team. Be as detailed as possible so we have all the info we need to ensure you get the best results.

If your goal is related to managing your weight, do you struggle with any of these issues? Tick all that apply:

Emotional eating

Anorexia

Bulimia

Overeating

Binge eating

Struggling to gain weight

None of the above

If you have any gut related issues such as Irritable Bowel Syndrome (IBS), Coeliac Disease or food intolerances please let us know if you have had any tests to confirm a diagnosis yet and any additional details about the problems you are having.

Are you under the care of any other health professional e.g. medical specialist or a psychologist regarding the issue you are needing support with from us?

Would you like your consultation by phone or video call?

Is there anything else you would like us to know about your goals and how we can help you? Or anything else that will help us with your booking?

Our Clinic Manager endeavours to reply to all enquiries within 24 hours (Monday-Friday excl holidays). Please make sure you check your junk/spam folder as our response may end up there.

I will check my spam folder

AIA Vitality Booking Enquiry

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