3-Day Food Journal


Food-JournalIt 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. Complete the following 3-day food journal for three consecutive days including one weekend day, and submit these results online at least one week 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
  • 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, for example: 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

3-Day Food Journal (Hard copy version)

Download the 3-Day Food Journal (PDF)

Links to submit the 3-Day Food Journal can be found below:

3-Day Food Journal (Online version)