Date:________________________

FOOD INTAKE RECORD

Record your food intake for a 24-hr period. Include ALL items consumed: meals, snacks, condiments, beverages,
supplements, etc. (use a separate form for EACH of your three days)
Day of week: SUN MON TUES WED THURS FRI

Time
of Day

SAT

Food Description
Meal

Dietary Analysis Project

(Include method of preparation, ex. Chicken

breast, fried, skin on)

Day:

Amount in
Common Units
(ex. cups, oz,
tbsp)

Eating
Motivation
(ex. Taste, hunger,
convenience,
social, emotional,
attitudes)

Date:________________________

Was this a typical day? YES

NO

Why or why not?

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Dietary Analysis Project