Consultation Enquiry

Please complete your details and we will be in touch to answer your questions and recommend the right consultant for you to meet.

Name

First Name

Last Name

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.

Do you have any other health conditions we need to be aware of to be able to best support you and match you with the right member of our team? e.g. Diabetes, PCOS etc

Please also let us know if you these conditions are under control, or if you are needing help with these as part of your work with us.

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?

If yes, please explain

Age group

Are you enquiring on behalf of a dependent?

Please can you provide their age

Location

e.g. Nelson, Christchurch

Email address

Phone number

Do you have insurance cover for a Registered Dietitian or Nutritionist and wish to claim back part of the cost of your consultation?

Note: Dietitians/Nutritionists are not eligible for pre approval. If you have cover, you can claim back the cost after the session.

AIA Vitality

If you are an AIA Vitality member, please enter your membership number here.

How did you hear about us

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.

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Consultation Enquiry

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