Discovery Call Application Form

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Apply for a complimentary 15 minute discovery call via Zoom to learn more about our nutrition coaching programs to support your fertility, pregnancy and hormone health!

Appropriate candidates will be contacted in the order in which they are received to book a call with founder, Stefanie Valakas, Expert Fertility Dietitian & Nutritionist. If Stefanie is not available for a call, you will be offered a call with a member of The Dietologist dietitian team!

Open to clients globally, time zone for appointments are for Sydney, Australia time (GMT+10).

Don't forget to check your junk mail - our responses often land in there!

Current wait times (subject to your and practitioner availability): 1-4 weeks

Email *

Full Name *

How old are you? *

Where do you live (include country)? *

How did you hear about The Dietologist? *

Instagram

Facebook

Facebook group - Fertility Friendly Food

Podcast - Fertility Friendly Food

Podcast interview

Friend/family member

Word of mouth

Doctor/medical professional

Other allied health professional (e.g. physio)

Other:

Select any of the following that applies to you? *

I have PCOS

I have endometriosis or adenomyosis

I have (or think I might have) irritable bowel syndrome

I have a thyroid concern such as hypothyroidism, Hashimoto's or Grave's disease

I have amennorrhoea or irregular menstrual cycles

I am having trouble with my body weight

I am wanting to freeze my eggs

I am planning to conceive in the next 3-12 months

I am planning for fertility treatments in the next 3 months

I have experienced a miscarriage and looking to work on preventing future losses

I am already pregnant!

Required

In a few sentences, please describe your reasons for wanting to work with The Dietologist team? *

Which statement best describes you? *

I am READY to invest time & resources into my own health and fertility and to make a long-lasting change in my lifestyle

I am curious to learn more about improving my health, but I am unsure whether this is the right time for me

If we are a good fit, how soon can you get started?

Working with Stefanie or The Dietologist team requires a minimum of a 3-month commitment Is this going to be an issue for you? *

Yes

How much are you willing to invest (for minimum 3 months support) in your issue if it meant reaching your goals? *

Less than $500 AUD

Between $500-1000 AUD

Between $1000-$3000 AUD

Whatever it takes to help get me there!

By submitting this form, you may be added to my email list, where you get exclusive offers, discounts and information. You may unsubscribe at any time. *

I understand that I can unsubscribe from the email list at any time

Required

I acknowledge this is a time slot allocated to me and if I cannot make this I will let The Dietologist know in advance (48 hours notice is ideal) so the time slot can reopen for our wait list. Should you fail to provide adequate notice or not show up for a discovery call, you may lose the right to future calls or services at our discretion. *

I have read and understood the terms.

Required

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