3 Day Dietary Log: Instructions

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7227 N 16th St.

, Suite 262
Phoenix, AZ, 85020

3 Day Dietary Log Page 1 of 4

Name Date

This dietary record must be as accurate as possible. Please do not alter your eating habits or change your
meals to change what is logged and please be honest. This log will aid your nutrition coach in creating the
best plan of action for your current behaviors and lifestyle.

Instructions
1. Please keep this log with you at all times and log meals, snacks, anything you eat as accurately as
possible.
2. If possible, please use a food scale or measuring spoons or cups. If you do not finish an entire serving
that was logged, please adjust the log accordingly. Do not guess and avoid estimating when possible.
3. Please list each ingredient in a meal separately.
4. For packaged items, use labels to determine quantities.
5. Please log for three consecutive days. If there are special events or circumstances that affect your
nutrition on a certain day, please note this in the margin of the log. This will provide your nutrition
coach with insight. If you wish to log for more than 3 days, please do.
6. Have this log completed and ready for your next session.

Example Log
Food Item Quantity Notes
(include brand name) (g, ml, tablespoons [Tbs], (include ingredients and amounts
teaspoons [tsp], cups [c], of homemade items)
etc)
Breakfast

2 pieces toast 2 pcs Orowheat

Margarine 1 tsp Country Crock .

Orange Juice 8 oz Tropicana

Lunch

Small pizza 12-inch diameter pepperoni, mushroom, cheese

Dinner

Chicken 4 oz Tyson

Baked Potato 8 oz

Mixed Vegetables 2 c peas, carrots, corn- frozen


7227 N 16th St., Suite 262
Phoenix, AZ, 85020

3 Day Dietary Log Page 2 of 4

Name Date

Day 1
Food Item Quantity Notes
(include brand name) (g, ml, tablespoons [Tbs], (include ingredients and amounts
teaspoons [tsp], cups [c], of homemade items)
etc)
7227 N 16th St., Suite 262
Phoenix, AZ, 85020

3 Day Dietary Log Page 3 of 4

Name Date

Day 2
Food Item Quantity Notes
(include brand name) (g, ml, tablespoons [Tbs], (include ingredients and amounts
teaspoons [tsp], cups [c], of homemade items)
etc)

.
7227 N 16th St., Suite 262
Phoenix, AZ, 85020

3 Day Dietary Log Page 4 of 4

Name Date

Day 3
Food Item Quantity Notes
(include brand name) (g, ml, tablespoons [Tbs], (include ingredients and amounts
teaspoons [tsp], cups [c], of homemade items)
etc)

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