Three Day Food Diary

Hooked on Fitness

Three Day Food Diary

www.HookedOnFitness.net

(215) 356-1976

A 3-Day Food Diary is a very useful tool to analyze dietary intake. As well as an accurately

recorded dairy of your food intake, personal information about your lifestyle and weight goals are required to best interpret the data.

How to fill in this diary

The following page contains questions about your contact details and personal history. The more information you can fill out, the better the interpretation will be. Fill in the 3-day food diary over three consecutive days, including one weekend day if possible. Please record all food and drinks at each time of the day you eat or drink. Make sure you include as much detail as possible. Be as specific as you can about the food type and amounts. Include all water and hot drinks in the drink category. Include any supplements such as vitamins, sports or herbal supplements you are taking. Incomplete forms cannot be analyzed. Print out additional pages if necessary.

Here is an example of how to fill out the page:

Time / Amount / Description
10.30 am / one / small apple
12.45 pm / 4 slices / Country Harvest brand thick slice bread
“ / 3 ounces / Jennie-O 99% fat free turkey breast
“ / 2 slices / full fat cheese
“ / 6 ounces / 100% orange juice

Once the form is complete

An accurately completed food dairy can provide a good approximation of a person’s dietary

intake. I will then be able to accurately process this information and provide a comprehensive analysis of micro and macro nutrient intake, plus give recommendations according to your diet and fitness goals based on the results.

Contact Details

Name: ______email: ______

Personal Details

Age: ______years Height: ______Weight: ______lbs / kgs Sex: male / female

Medical

Any injuries or sickness or ongoing medical issues? ______

Any allergies / intolerances? ______

Nutritional

Weight goal (circle one): gain / lose / maintain. If gain or lose, how much? ______lbs / kgs

Any nutritional concerns? ______

Relevant social situation - do you cook yourself, work nights etc.? ______

Details: ______

Do you take any supplements/vitamins/sports drink/powders etc.? ______

Details: ______

Exercise

Do you play sport or have specific fitness goals? ______

Current Physical Activity Level (circle one): low / moderate / heavy

Please fill in the following table of your activities for the three days that you filled out the food and beverage diary:

Day / Activity (run, walk, bike, swim, weights, etc.) / Intensity / Duration (minutes)
1
2
3

Food Diary Day One

Time / Amount / Description
9 am / Give as tsp,Tbsp, cups,oz, weight or portion size / Give a detailed description including type of food, brand name, or restaurant

Food Diary Day Two

Time / Amount / Description
9 am / Give as tsp,Tbsp, cups,oz, weight or portion size / Give a detailed description including type of food, brand name, or restaurant

Food Diary Day Three

Time / Amount / Description
9 am / Give as tsp,Tbsp, cups,oz, weight or portion size / Give a detailed description including type of food, brand name, or restaurant

© HookedOnFitness.net

For detailed instructions on how to fill in this food diary, see http://www.hookedonfitness.net/Food-Diary-Guidelines.html