Life Choices Counseling ©

Food Journal - Fax to (928) 282-0084. Phone for consultation (928) 282-0084

INSTRUCTIONS: For the next three days keep track of what you are eating/drinking, how much and when.

DATE: _____________

BREAKFAST: Time_________ :___________________________________________________

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LUNCH: Time_________:________________________________________________________

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DINNER: Time:_______:_________________________________________________________

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SNACKS: Time:_______:_________________________________________________________

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DATE: _____________

BREAKFAST: Time_________ :___________________________________________________

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LUNCH: Time_________:________________________________________________________

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DINNER: Time:_______:_________________________________________________________

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SNACKS: Time:_______:_________________________________________________________

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DATE: _____________

BREAKFAST: Time_________ :___________________________________________________

______________________________________________________________________________

______________________________________________________________________________

LUNCH: Time_________:________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

DINNER: Time:_______:_________________________________________________________

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SNACKS: Time:_______:_________________________________________________________

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NOTES:_______________________________________________________________________

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