Daily Food Record: Sample
 

Meal

Time of day

Food Name

Amount

Eaten

Brand or restaurant

Method of Preparation

Breakfast

7:00am

2 med eggs

2

scrambled

Toast

2

White bread

toasted

Jam

2 tsp

Strawberry

Butter

Orange juice

2 tsp

1 cup

Salted

Minute maid with calcium

Snack

10:30am

Candy bar

1 regular

Snickers

Cola

1 can

Pepsi

Lunch

2:00pm

Double Cheeseburger

1

McDonald’s

Mayo, no mustard

French fries

1 regular

same

Ice tea

Medium

Same

sweetened

Snack

none

Dinner

Pizza

3 slices

Dominos

Cheese, pepperoni

Salad

2 cups

Mixed greens

Dressing

2 Tbs

Ranch

Dessert

Cookies

6

Oreos

Milk

1 cup

Whole

 
 
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