3 Day Food Diary
In order for Rittenhouse Women's Wellness Center to evaluate your dietary routine and nutrient intake, we would like for you to fill out this food diary in which you will record all that you eat for three consecutive days, including one weekend day (to ensure an accurate analysis of your nutritional status). All of your recordings must include the date, time of day of consumption, all foods (with ingredients listed, if possible), beverages and supplements consumed, and amounts of all foods, beverages and supplements consumed. Please indicate the amount of all foods and beverages you consume, as well as the preparation method (i.e., grilled, fried, baked, etc.). Make sure to also record any dips, condiments or salad dressings you consume as well. Please include brand names (name of restaurant and/or brands of ingredients) of all foods, beverages and supplements, if possible. Please be as honest and accurate as possible so that we can better assist you with nutritional assessments and recommendations.
Example of meal recording: 1 cup of 2% milk; 1 cup of spring water; ½ cup of grilled, wild salmon; Three cups of Asian Chicken Salad: including 3 oz of stir fried chicken, Two handfuls of romaine lettuce, ¼ cup of cabbage, Four mandarin orange slices, One small handful of crispy wonton strips, Two tablespoons of Newman's Own low fat sesame ginger dressing, One small handful of candied walnuts.
Food Diary Day 1
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Food Diary Day Two
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Food Diary Day 3
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