INSTRUCTIONS

  • Please write down all foods and beverages consumed for three 24-hour time periods. Each day starting at 12:00 am and ending at 11:59 pm. Choose three consecutive days, including two weekdays and one weekend.
  • You will be asked to record all vitamin, mineral, and herbal supplements you took at the end of each record.
  • List the approximate Time the meal was consumed
  • List each Food/Beverage Item you consumed, including foods eaten between meals and all drinks, even if it is a non-caloric item like water, coffee, tea, or sugar-free gum
  • Record the Amount of each food or beverage consumed. Portion sizes can be recorded in a variety of ways, please use the method that works best for you.
Three Day Food Record Example Table

MM slash DD slash YYYY
Meal table
Please click + to add a new item
Time
Food/Beverage Item
Amount
 
Please list all vitamin, mineral, and herbal supplements you took today
Type of Supplement
Reason for Taking
 
Please list all planned physical activity performed today.
Activity Type
Duration (minutes or hours)
 

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