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Daily Food & Liquid Intake Form
Whether you're trying to lose weight or you want to see what
effect diet is having on your health, we've provided the food and liquid
intake form to help you manage your diet. Your on-line doctor/clinician may
require that you track your diet for a period of time to help you follow
your on-line program.
INSTRUCTIONS:
Each day come to this page to enter what foods and liquids
you consume. Your online doctor/clinician will view your
data and will go over dietary recommendations either by
email or by phone.
The "start date" is automatically filled in for you. The end date will by 7 days after the start date. When you have completed the first day YOU MUST PRESS "SAVE DATA FOR THIS DAY".
When you have entered all of the data for the day, YOU MUST PRESS "THIS DAY IS COMPLETE". Once the first day is complete, you will then be able to enter data for the second day.
Select the day you want to enter your diet information:
The "start date" is automatically filled in for you. The end date will by 7 days after the start date. When you have completed the first day YOU MUST PRESS "SAVE DATA FOR THIS DAY".
When you have entered all of the data for the day, YOU MUST PRESS "THIS DAY IS COMPLETE". Once the first day is complete, you will then be able to enter data for the second day.
Select the day you want to enter your diet information:
| Start Date | {date} | End Date | {date} |
| Day 1 | {complete} | Day 4 | {date} |
| Day 2 | {date} | Day 5 | {date} |
| Day 3 | {date} | Day 6 | {date} |
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| DAY ONE {date} | ||
| Breakfast:
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Meat & Dairy foods: |
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Vegetables & Fruits |
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Cereal foods |
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Candy and other sweets |
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Drinks |
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| Between Breakfast & Lunch: | ||
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| Lunch:
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Meat & Dairy foods |
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Vegetables & Fruits |
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Cereal foods |
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Candy and other sweets |
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Drinks |
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| Between Lunch & Dinner: | ||
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| Dinner:
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Meat & Dairy foods |
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Vegetables & Fruits |
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Cereal foods |
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Candy and other sweets |
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Drinks |
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| Between Dinner & Bedtime: | ||
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