Client Form

Please fill out the following confidential form and Emily will be in contact as soon as possible. Thank you.

For urgent or timely requests (interviews/media appearances) please contact Emily directly at 587.987.5595 or

Request Form

I have read about services offered by Food First Nutrition Consulting and I would like to:

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Your Personal Information

First Name:
Last Name:
Date of Birth (mm/dd/yyyy):

Gender: MaleFemale

Your Contact Information

Street Address:
Postal Code:
Home Phone:
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Preferred method of communication:

Your Appointment Information

My nutrition goals include:

eating for sport performancegaining lean musclemanaging food allergy or intolerancesupporting nutrition for my infant, child or teeneating for a healthy pregnancyother, write below:

Additional information you wish to share:

Preferred times:
Weekday, weekend and evening appointments are available. What is your preferred day of week/time of day for your initial 30-minute consultation?


Don't live in Edmonton, or prefer online coaching? Emily also offers appointments by telephone and Skype.

Yes! I am interested in working with Emily by phone.Yes! I am interested in working with Emily by Skype.

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Note: All information is protected and confidential.