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Work With Me – Application Form

I’m on a mission to empower women to take charge of their health without dieting or restriction. 

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I get it. There’s a LOT of nutrition information out there, and it can feel impossible to know which advice to follow. I can help you cut through the noise and develop a nutrition plan tailored to you and your peri-menopause to menopause health goals.

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Please complete this application form and once reviewed, if you are a suitable candidate for my 12 week 1:1 Princess Peri Program, you will be offered a 15 minute connection call.

Best way to communicate with you
Phone call
Email
SMS
At this stage, Gia works with women who are navigating their menopause journey through nutrition, lifestyle (movement, mindset, stress management) and supplementation. Please confirm if this is what you would like get out of working with Gia.
Yes
No

1 = I need alot of support around my health, 10 = I am on top of my overall health with no concerns moving forward

What are your biggest struggles at this stage of your life?
Are you willing to invest both financially and emotionally in the process of working with me as your perimenopause/menopause dietitian and health coach over a 12 week period? Together we will navigate all areas and support you with your goals, but please
Yes
No
I am unsure and need to see what is included
Other - please provide information
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