Chinese Nutrition: Daily Food Journal

Please complete the food journal each day for 7 days, submitting a new form each day.

Name

First Name

Last Name

Date

Waking Time

Please note your waking time.

Breakfast

Please list the foods and beverages you consumed for breakfast, how they were prepared, at what time and how they made you feel.

Lunch

Please list the foods and beverages you consumed for lunch, how they were prepared, at what time and how they made you feel.

Dinner

Please list the foods and beverages you consumed for dinner, how they were prepared, at what time and how they made you feel.

Snacks

Please list the foods and beverages you consumed for snacks, at what time and how they made you feel.

Water Intake

Please note total water intake. You should include other beverages not accounted for in other categories here.

Physical Activity

Please list time of work out and type of exercise throughout the day.

Sleep Time

Please note the time you went to sleep.

Dr. Krystal Couture