Sample Diet Diary

Diet Diary for:

Date:

Please record any food, drinks, candy, lozenges, etc. and the time they were consumed.
One of the three days should represent a weekend or day off, to include variations in the menu.

For example:

7AM Coffee with sugar, cream, bran muffin

9AM Coffee with sugar, cream

10AM Sugarless gum

12 PM Hamburger, fries with ketchup, chocolate milk shake

2PM Cough Lozenge

Time                                           Day 1                                             Day 2                                              Day 3

AM 6:00

7:00

8:00

9:00

10:00

11:00

PM 12:00

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

11:00

AM 12:00

1:00

2:00

3:00

4:00

5:00