Client Action Plan — Emma Crawford Nutrition

01 Client & Session Details

Client Name

Date of Birth

Consultation Date

Clinician / Nutritionist

Plan Number

Plan Review Date

Measurements

Measurement	Today	Previous	Change

02 My Motivations & Personal Vision

My main reason for making these changes is:

In 12 weeks' time I want to feel / look / be able to:

What has stopped me before, and what will be different this time?

03 Overall Targets

Target	Current	Goal	Timeframe

04 My SMART Goals

Goals should be Specific · Measurable · Achievable · Relevant · Time-bound

Goal 1 Nutrition

What I will do (specific action)

Why this matters to me

How I will do it (steps / strategy)

When I will do it (days / times)

Any potential barrier

How I will overcome it

Target date

Confidence (1–10)

5

Not at allVery confident

Goal 2 Nutrition

What I will do (specific action)

Why this matters to me

How I will do it (steps / strategy)

When I will do it (days / times)

Any potential barrier

How I will overcome it

Target date

Confidence (1–10)

5

Not at allVery confident

Goal 3 Physical Activity

What I will do (specific action)

Why this matters to me

How I will do it (steps / strategy)

When I will do it (days / times)

Any potential barrier

How I will overcome it

Target date

Confidence (1–10)

5

Not at allVery confident

Goal 4 Lifestyle & Behaviour

What I will do (specific action)

Why this matters to me

How I will do it (steps / strategy)

When I will do it (days / times)

Any potential barrier

How I will overcome it

Target date

Confidence (1–10)

5

Not at allVery confident

Goal 5 Mindset & Wellbeing

What I will do (specific action)

Why this matters to me

How I will do it (steps / strategy)

When I will do it (days / times)

Any potential barrier

How I will overcome it

Target date

Confidence (1–10)

5

Not at allVery confident

05 Weekly Habit Tracker

Use this tracker each week to record whether you completed your key goals and habits. Tick each day you achieved it.

Goal / Habit	Mon	Tue	Wed	Thu	Fri	Sat	Sun

Week commencing

Total days achieved

How did this week go? What helped, and what made it harder?

06 Dietary Focus

6.1 Agreed Dietary Approach

Tick the approach(es) agreed with your nutritionist for this plan.

6.2 My Daily Nutrition Targets

Target	Amount / Guidance

6.3 Foods to Focus On

Foods to include more of — agreed with nutritionist

6.4 Foods to Reduce or Avoid

Foods or drinks to cut back on or eliminate

6.5 Practical Tips & Meal Ideas

07 Physical Activity Plan

Activity	Frequency	Duration	Intensity	Notes / How to progress

Steps / movement target per day

Current daily average

08 Support & Accountability

8.1 My Support Network

Person / organisation providing support

How they will help me

Anyone I need to tell about my plan

8.2 If I'm Struggling

If I'm finding it hard to stick to my plan, I will:

Contact the clinic for support · 📞 📧 emmacrawfordnutrition.co.uk

09 Progress Review

To be completed at your next appointment with your nutritionist.

#	Goal	Progress	Outcome	Next Step

9.1 Measurements at Review

Measurement	At Review	At Start	Change

9.2 Overall Progress Notes

9.3 Client Wellbeing Check

How has the client been feeling overall since the last appointment?

Any concerns or new symptoms to note?

10 Next Steps & Updated Plan

Goals continuing unchanged

Goals being updated / replaced

New goals being added

Referrals / onward actions

Medication review needed?

Next appointment date

Review interval

Additional notes / updated recommendations

11 Agreement & Sign-off

Client declaration: I have agreed the goals and plan set out in this document with my nutritionist. I understand this plan is a guide to support my progress and that I can discuss any changes with my clinician at any time.

Client

Signature

Date

Name (print)

Clinician

Signature

Date

Name (print)

Role

Terms & Conditions

Location

Contact