Food Journal — Eating Understood

Daily Food Journal

Once you have set up an appointment, please provide a record of all meals, snacks and beverages consumed for 3-4 days. Include the amounts of food and drink. If you notice any digestive, body (ex. headache) or mood changes, note that as well. Include at least one weekend day. Please be honest, there is no judgement here.

Fill out the information below and submit it or print a PDF, upload and email or send it back later prior to scheduled appointment. (If submitting online, you’ll need to log all information manually and then submit all the days together).

Name

First Name

Last Name

DAY 1 - Date

MM

DD

YYYY

Breakfast & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Lunch & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Dinner & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Dessert/snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

DAY 2 - Date

MM

DD

YYYY

Breakfast & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Lunch & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Dinner & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Dessert/snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

DAY 3 - Date

MM

DD

YYYY

Breakfast & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Lunch & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Dinner & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Dessert/snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

DAY 4 - Date

MM

DD

YYYY

Breakfast & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Lunch & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Dinner & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

Dessert/snack & beverages

List: Time, food, beverages including amounts and any mood or digestive changes.

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Eating Understood Nutrition and Wellness