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diet-nutrition-and-lifestyle-journal-7-day
Diet, Nutrition, and Lifestyle Journal – 7 Day
Patient Name
Date:
Not Set
Food Plan Type:
Day 1
Day Event
Food & Drink Intake (include type, amount, brand)
Macronutrients (PFC) and Phytonutrients
Rising Time
Breakfast
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-AM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Lunch
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Dinner
Time
P
F
C
ROYGB/P/BLW/T/BR
PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Bed Time
P: Proteins;  F: Fats;  C: Carbohydrates;  R: Red;  O: Orange;  Y: Yellow;  G: Green;  B/P/BL: Blue/Purple/Black;  W/T/BR: White/Tan/Brown
Sleep & Relaxation
Exercise & Movement
Stress
Relationships
Sleep
Quantity: (hours)
Quality:
PoorFairGoodRelaxation
YesNo
Type/Amount:
Type, Duration, & Intensity
Quality:
Aerobic:
Strength:
Flexibility:
Stress Reduction Practices:
Stressors:
Supporting:
Non-supporting:
Mental
Emotional
Spiritual
diet-nutrition-and-lifestyle-journal-7-day
Diet, Nutrition, and Lifestyle Journal – 7 Day
Patient Name
Date:
Not Set
Food Plan Type:
Day 2
Day Event
Food & Drink Intake (include type, amount, brand)
Macronutrients (PFC) and Phytonutrients
Rising Time
Breakfast
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-AM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Lunch
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Dinner
Time
P
F
C
ROYGB/P/BLW/T/BR
PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Bed Time
P: Proteins;  F: Fats;  C: Carbohydrates;  R: Red;  O: Orange;  Y: Yellow;  G: Green;  B/P/BL: Blue/Purple/Black;  W/T/BR: White/Tan/Brown
Sleep & Relaxation
Exercise & Movement
Stress
Relationships
Sleep
Quantity: (hours)
Quality:
PoorFairGoodRelaxation
YesNo
Type/Amount:
Type, Duration, & Intensity
Quality:
Aerobic:
Strength:
Flexibility:
Stress Reduction Practices:
Stressors:
Supporting:
Non-supporting:
Mental
Emotional
Spiritual
diet-nutrition-and-lifestyle-journal-7-day
Diet, Nutrition, and Lifestyle Journal – 7 Day
Patient Name
Date:
Not Set
Food Plan Type:
Day 3
Day Event
Food & Drink Intake (include type, amount, brand)
Macronutrients (PFC) and Phytonutrients
Rising Time
Breakfast
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-AM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Lunch
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Dinner
Time
P
F
C
ROYGB/P/BLW/T/BR
PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Bed Time
P: Proteins;  F: Fats;  C: Carbohydrates;  R: Red;  O: Orange;  Y: Yellow;  G: Green;  B/P/BL: Blue/Purple/Black;  W/T/BR: White/Tan/Brown
Sleep & Relaxation
Exercise & Movement
Stress
Relationships
Sleep
Quantity: (hours)
Quality:
PoorFairGoodRelaxation
YesNo
Type/Amount:
Type, Duration, & Intensity
Quality:
Aerobic:
Strength:
Flexibility:
Stress Reduction Practices:
Stressors:
Supporting:
Non-supporting:
Mental
Emotional
Spiritual
diet-nutrition-and-lifestyle-journal-7-day
Diet, Nutrition, and Lifestyle Journal – 7 Day
Patient Name
Date:
Not Set
Food Plan Type:
Day 4
Day Event
Food & Drink Intake (include type, amount, brand)
Macronutrients (PFC) and Phytonutrients
Rising Time
Breakfast
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-AM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Lunch
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Dinner
Time
P
F
C
ROYGB/P/BLW/T/BR
PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Bed Time
P: Proteins;  F: Fats;  C: Carbohydrates;  R: Red;  O: Orange;  Y: Yellow;  G: Green;  B/P/BL: Blue/Purple/Black;  W/T/BR: White/Tan/Brown
Sleep & Relaxation
Exercise & Movement
Stress
Relationships
Sleep
Quantity: (hours)
Quality:
PoorFairGoodRelaxation
YesNo
Type/Amount:
Type, Duration, & Intensity
Quality:
Aerobic:
Strength:
Flexibility:
Stress Reduction Practices:
Stressors:
Supporting:
Non-supporting:
Mental
Emotional
Spiritual
diet-nutrition-and-lifestyle-journal-7-day
Diet, Nutrition, and Lifestyle Journal – 7 Day
Patient Name
Date:
Not Set
Food Plan Type:
Day 5
Day Event
Food & Drink Intake (include type, amount, brand)
Macronutrients (PFC) and Phytonutrients
Rising Time
Breakfast
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-AM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Lunch
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Dinner
Time
P
F
C
ROYGB/P/BLW/T/BR
PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Bed Time
P: Proteins;  F: Fats;  C: Carbohydrates;  R: Red;  O: Orange;  Y: Yellow;  G: Green;  B/P/BL: Blue/Purple/Black;  W/T/BR: White/Tan/Brown
Sleep & Relaxation
Exercise & Movement
Stress
Relationships
Sleep
Quantity: (hours)
Quality:
PoorFairGoodRelaxation
YesNo
Type/Amount:
Type, Duration, & Intensity
Quality:
Aerobic:
Strength:
Flexibility:
Stress Reduction Practices:
Stressors:
Supporting:
Non-supporting:
Mental
Emotional
Spiritual
diet-nutrition-and-lifestyle-journal-7-day
Diet, Nutrition, and Lifestyle Journal – 7 Day
Patient Name
Date:
Not Set
Food Plan Type:
Day 6
Day Event
Food & Drink Intake (include type, amount, brand)
Macronutrients (PFC) and Phytonutrients
Rising Time
Breakfast
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-AM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Lunch
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Dinner
Time
P
F
C
ROYGB/P/BLW/T/BR
PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Bed Time
P: Proteins;  F: Fats;  C: Carbohydrates;  R: Red;  O: Orange;  Y: Yellow;  G: Green;  B/P/BL: Blue/Purple/Black;  W/T/BR: White/Tan/Brown
Sleep & Relaxation
Exercise & Movement
Stress
Relationships
Sleep
Quantity: (hours)
Quality:
PoorFairGoodRelaxation
YesNo
Type/Amount:
Type, Duration, & Intensity
Quality:
Aerobic:
Strength:
Flexibility:
Stress Reduction Practices:
Stressors:
Supporting:
Non-supporting:
Mental
Emotional
Spiritual
diet-nutrition-and-lifestyle-journal-7-day
Diet, Nutrition, and Lifestyle Journal – 7 Day
Patient Name
Date:
Not Set
Food Plan Type:
Day 7
Day Event
Food & Drink Intake (include type, amount, brand)
Macronutrients (PFC) and Phytonutrients
Rising Time
Breakfast
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-AM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Lunch
Time
P
F
C
ROYGB/P/BLW/T/BR
Mid-PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Dinner
Time
P
F
C
ROYGB/P/BLW/T/BR
PM Snack
Time
P
F
C
ROYGB/P/BLW/T/BR
Bed Time
P: Proteins;  F: Fats;  C: Carbohydrates;  R: Red;  O: Orange;  Y: Yellow;  G: Green;  B/P/BL: Blue/Purple/Black;  W/T/BR: White/Tan/Brown
Sleep & Relaxation
Exercise & Movement
Stress
Relationships
Sleep
Quantity: (hours)
Quality:
PoorFairGoodRelaxation
YesNo
Type/Amount:
Type, Duration, & Intensity
Quality:
Aerobic:
Strength:
Flexibility:
Stress Reduction Practices:
Stressors:
Supporting:
Non-supporting:
Mental
Emotional
Spiritual
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