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Food
Diary
Your Name _________________________________
Date of Food Record _________________________
Please keep a record of everything you eat in one day. Try to use a day that is typical. Write down everything you eat and drink during that day. Be sure to include anything you add to your food, such as butter, margarine, salad dressing, mayonnaise, etc. Please record portions in tablespoons, teaspoons, cups or other measures. It you need more space use another page.
| Time |
Type of Food |
How Much? |
Where Eaten |
| Breakfast or first meal of the day
|
|
|
|
| Snack
|
|
|
|
| Lunch
|
|
|
|
| Snack
|
|
|
|
| Dinner
|
|
|
|
| Evening & night snacks |
|
|
|
| Special notes |
|
|
|
10/20/04