FOOD INTAKE RECORD

Name_____Brooke Bryant_____________________________________________________

DAY

TIME

AMOUNT

FOOD

MEAL OR
SNACK

WHERE DID I
EAT?
With friends or
alone

How did I feel?

Tired, hungry,
stressed, happy

Example:
4-24-10

9:30 am

1 cup

Fresh Strawberries

snack

Very hungry

02-08-2016
02-08-2016
02-08-2016
02-08-2016
02-08-2016
02-08-2016
02-08-2016
02-08-2016
02-08-2016
02-08-2016
02-08-2016

6:30am
6:30am
6:30am
10:00am
10:00am
10:00am
11:45am
11:45am
11:45am
2:00pm
5:30pm

1/2cup
1/2cup
8oz
2String Cheese
1small
8oz
3oz
1cup
1/2cup
2tbs
3oz

1%cottage cheese
Fresh pineapple
Water
1%string cheese
Mandarin orange
Water
Grilled chicken
Green beans
corn
Almonds
Turkey patty

meal
meal
Drink
snack
snack
Drink
Meal
Meal
Meal
snack
Meal

02-08-2016

5:30pm

1/2small

Meal

02-08-2016

5:30pm

1/2cup

Baked
potato,cheese,sourcream
Baby carrots

02-08-2016

5:30pm

8oz

Water

Drink

02-08-2016
02-08-2016
02-08-2016

6:00pm
8:30pm
9:00pm

8oz
1
8oz

Water
String cheese
Water

Drink
Snack
Drink

Alone at dining
hall
Alone at home
Alone at home
Alone at home
At school alone
At school alone
At school alone
At School alone
At school alone
At school alone
At school alone
With parents at
home
With parents at
home
With parents at
home
With parents at
home
Alone
Alone
Alone

Meal

Would you follow this diet again?

Yes, I would follow this diet again.
Why or why not? (One complete sentence)
I would follow this diet again because I do not consume many gluten containing products and it puts me on a lower carb diet.

Stressed/hungry
Stressed/hungry
Stressed
Stressed
Stressed/tiered
N/a
Hungry
Hungry
Hungry
Hungry
Hungry
Hungry
Hungry
Thirsty
Thirsty
Hungry/Stressed
Stressed