Application Form
Apply to work 1:1 with Dr. Gio
Functional medicine practitioner and clinical nutritional therapist
Email *
Name *
Last Name *
Optional - Phone number (+ country code) 
Do you have any medical diagnosis? if so, please specify which one (s) and how long you have been suffering/diagnosed? *
do you have any recent blood test results or clinical report (max 6 months ago)? please specify *
Which are your top 3 health concerns and priorities? *
Have you already tried to solve your health issues? if so, how? *
How do you define your relationship with food and your body image? *
Required
Which clinical condition/s best describes you (please note that we are not expert in vegan and vegetarian/full plant-based approaches) *
Required
In order to achieve optimal results, commitment and dedication are required. Do you feel ready to invest in your health? *
Only remote consultations are available. Are you happy to proceed with it? *
Would you like to subscribe to our newsletter? if so, please enter your best email address *
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