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1. Download PDF below and print 3 copies.

Complete a 3-day food record. That includes everything you ate and drank for the entire three days. Including any and all snacks. 


2. Be as specific as possible.

Be sure to put the AMOUNT of food you had at each meal or snack and the time of day. For example: 1 cup of cheerios cereal with 1 cup of 2% milk and 1/2 cup of chopped strawberries + 1 cup of coffee with 2 teaspoons of sugar. 


3. Send to me before our next visit.

Please scan and email to Jessica at jessicamjones [at] gmail [dot] com. Note: You can download CAM SCANNER to scan and email via your smart phone for free. Please put "Food Record for [your name]" in the subject of the email. 

If creating a food record is trigging for you, please do not do this activity. Also please note that your food intake will not be judged as "good" or "bad". Everything mentioned will be reviewed from a neutral perspective. 



Food Record

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