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Healthy Food

Thank you for choosing to work with me. To get things rolling I would be grateful if you could fill in the information asked below. This helps me get a good understanding of your current fitness level, goals, diet and generally a bit about you.

The more information you can supply the better I can make your plan more bespoke for you and in order to create a great skincare plan.

All information given is kept confidential and I request that the information supplied is used solely by you and is not shared.

The consultation is split into three sections; Nutrition Analysis, Physical Training Analysis & Food Diary. Please fill in all sections before submitting. Please answer the questions truthfully and accurately.

There is a goal-setting question for each section. Adding facts and figures to this goal will help you track your progress and evaluate the results. We can also review your goals and provide the relevant and correct advice.

Use the SMART principle when setting goals.

This is;

Specific – What exactly do you want to achieve using this plan? E.g. better skin health

Measurable – What methods can you use to record progress? E.g. Mirror/images

Actionable – What do you believe is required to achieve your goal? E.g. better food choices

Realistic – Can you achieve this goal, even with help? What might hold you back?

Time frame– By when do you want to achieve your goal?

Initial health coaching consultation form

Please fill out the following form to help us understand your physical condition.

Please complete this form a minimum of 48 hours before your online consultation with Emmaline. 

Please make payment for the online consultation within 48 hours of making an appointment to confirm your booking.
Any online consultations that have not been paid for within this time frame will not be carried out

Please be aware this consultation is not a replacement for medical advice.

Results can vary from client to client and any opinions are solely my own. 

As a health coach I am not permitted to diagnose, or claim to treat, medical conditions.


As a client...

  • you are responsible for contacting your GP about any health concerns.

  • You must understand that the advice is personal to you and may not be appropriate for others.

  • You declare that all the information we share during this professional relationship is confidential and to the best of our knowledge, true and correct.

Are you currently...

Thanks for submitting!


It is essential to look at your current nutrition in order to maximize the help I can provide you with and to get the correct starting point for your nutrition plan. By looking at your current diet I will be able to see your current nutrition lifestyle and find any problems within it. I can then tailor your new plan to remove these problems while still respecting your lifestyle so we can achieve your results while making the integration process as easy as possible.

Please detail all food, liquids and supplements that you consume for at least the next 3 days. After 3 days of consistently tracking your food please email me the food diary after you have completed the consultation. Please send this email to


Thank you for completing the consultation process, this greatly benefits me for creating your plan, getting to know you and provide you with the best advice and support. I hope it has encouraged you to think hard about your goals, were you currently stand in achieving these and how to achieve them. By doing so you have already completed one of the main hurdles that face people when trying to achieve their ideal body health.

Thank you so much


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