Three-Day Dietary Record
It is important that this record be both accurate and representative of your normal dietary intake.
Thus it is essential that you do not alter your normal eating habits in any way and that you record as
precisely as possible every single item that you consume (this includes water, vitamins, condiments,
etc.). To do so, you must follow a few simple instructions (listed below). The purpose here is to
correctly record and quantify your normal intake, not to judge it. If you change your eating habits in
any way, then we cannot accurately analyze your typical diet. The procedure may seem somewhat
cumbersome, but remember, it is only three days.

You may choose to record your dietary record using the form below or using an app such as My Fitness Pal or FatSecret. If choosing to use an app, please make sure that your records can be shared with me via email.

Use a small food scale if you have one, or use standard measuring devices (e.g., measuring cups, measuring spoons) to record the quantities consumed as accurately as possible. If you do not eat all of the item (for instance a portion of an apparently delicious hastily prepared casserole of leftovers that turned out to be not so delicious), re-measure what’s left and record the difference. Record combination foods separately (e.g., hot dog, bun, and condiments) and include brand names of food items (list contents of homemade items) whenever possible. For packaged items, use labels to determine quantities. Record three days that are representative of your normal intake. Therefore if your weekdays are different from your weekends, pick two weekdays and one weekend. Likewise, if your M, W, and F are different from your T and Th and all these days are different from your Sat and Sun, you should pick one day to represent each unique schedule.

Name
Day 1 Date
MM
/
DD
/
YYYY
Day 1
Include food item (brand names), quantities (g, mL, tablespoons, teaspoons, cups, etc), and any other notes (ingredients in recipes, oils used to prepare, etc)
Day 2 Date
MM
/
DD
/
YYYY
Day 2
Include food item (brand names), quantities (g, mL, tablespoons, teaspoons, cups, etc), and any other notes (ingredients in recipes, oils used to prepare, etc)
Day 3 Date
MM
/
DD
/
YYYY
Day 3
Include food item (brand names), quantities (g, mL, tablespoons, teaspoons, cups, etc), and any other notes (ingredients in recipes, oils used to prepare, etc)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms