3-Day Food Journal (Day 1)

It is important for you to keep an accurate record of your usual food and beverage intake so that I might determine how your food affects the rest of you.
Please complete the following 3-Day Food Journal for three consecutive days including one weekend day, and submit these results online at least 24 hours before your consultation with me.
• Do not change your eating behavior at this time. The purpose of this food record is to analyze your present eating habits. There is ZERO judgment on my end, I promise.
• Record information as soon as possible after the food has been consumed.
• Identify who you were eating with (spouse, family, friend, alone).
• Describe all foods and beverages consumed as accurately and in as much detail as possible including estimated amounts, brand names, cooking method, etc.
• Record the amount of each food or beverage consumed using standard measurements such as 8 ounces, 1 cup, 1 teaspoon, etc.
• Include any added items (i.e. tea with 1 teaspoon of honey, potato with 2 teaspoons butter, etc.).
• List all beverages and types, including water, coffee, tea, sports drinks, sodas/diet sodas, etc.
• Comment on any noted emotional mood (happy, excited, depressed) or physical symptoms including hunger level, stress, bloating, fatigue, adverse reaction experienced, etc.
• Include comments about eating habits and environment such as reasons for skipping a meal; when a meal was eaten at a restaurant, in a car, at a picnic, etc.
• Each day note all bowel movements, describe their consistency (regular, loose, firm, etc.), frequency, and any additional information. (Again, ZERO judgment.)

Day 1

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