Skip Maine state header navigation

Agencies | Online Services | Help

 

Food Diary

                                            Your Name _________________________________

                                  Date of Food Record _________________________       

Please keep a record of everything you eat in one day. Try to use a day that is typical. Write down everything you eat and drink during that day. Be sure to include anything you add to your food, such as butter, margarine, salad dressing, mayonnaise, etc. Please record portions in tablespoons, teaspoons, cups or other measures. It you need more space use another page.

      

Time

Type of Food

How Much?

Where Eaten

Breakfast or first meal of the day

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Snack

 

 

 

 

 

 

Lunch

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Snack

 

 

 

 

 

 

Dinner

 

 

 

 

 

 

 

 

 

Evening & night snacks

 

 

 

Special notes

 

 

 

                                                                                                                                         10/20/04