Topics Map > Self Care > Nutrition > Patient
Food, Drink, Activity, and Symptom Log
Use this log to record your eating habits, other health behaviors, and how you feel. Jot down everything you eat and drink for a week or two. Include weekdays and days on the weekend. This log has space for two days. Use more pages as needed. Include the amount or size of the food or drink (one large apple, 1 cup of lettuce, 8 ozs. of coffee). Be specific. (For example, does your drink contain caffeine? What’s in your salad or casserole?) Do you see any unhealthy habits that you would like to change? Do you see any connections between how you feel and your habits? Use this information as you set health goals.
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Fill in Date and Day of Week |
Fill in Date and Day of Week |
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Record food and amount |
Record food and amount |
Breakfast |
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Morning Snacks |
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Lunch |
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Afternoon Snacks |
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Dinner |
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Evening Snacks |
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Record other things that were happening on these days |
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Number of hours I slept |
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Ways I relaxed |
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How active I was |
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Overall how stressed I felt |
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