foodrecords-NutritioninAction.docVIP

Nutrition in action Professional Education Services Food and Activity Record Please provide the following information. Complete the attached intake and activity record and return it to our office by ________________________ prior to your next appointment. Failure to meet this deadline will result in a re-scheduling of your 2nd appointment. Thank you! Instructions: To assist you in reaching your nutrition goals whether it is for fueling athletic performance or general health, it is important to know your current eating habits in order to customize a nutrition plan for you! On the following pages, you will find sheets to record your “typical” food intake over a three (3) day period, two (2) week days and one (1) weekend day, prior to your 2nd visit with the dietitian. Also enclosed is an activity record to be completed for the same 3 days. Record all food and beverage intake over 3 days (2 weekday and 1 weekend day), i.e Monday, Tuesday and Sunday Do not change your eating habits during the three record intake days Record food and beverage intake as you eat/drink them, as well as the time of consumption BE as exact as possible in estimating portion amounts (ie. 3 ounces 90-110g = a deck of cards) of meat, ? c or 250ml of milk, 1 tablespoon, 15ml of peanut butter, etc.) Se specific as you can in terms of sweetened or unsweetened (juice, cereal etc.), kinds of milk and alternates, also list things added to food/meals, ie.1% milk, Tea, etc. Don’t forget to list salad dressings, condiments, butter, margarine, jams, oils etc. added to foods. Also list the ingredients in certain combination meals (i.e tuna casserole). Indicate how the food was prepared (fried, broiled, grilled, steamed) Please record in detail your activity for the 3 days, including sleep times, walking, standing, eating, sitting, driving, watching TV., computer use etc. for a total of 24 hours/day. If you are involved in sports or are physically active, include warm ups and daily training activitie