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Form to monitor food intake over one week


This form can help you to monitor your food intake. Fill it in carefully every day, noting the amount you eat each time. List all the amounts of food you eat daily for every day of the week. Review the form or discuss it with your nutritionist, doctor, nurse, local health worker or counsellor after one week. Compare the sheets from week to week to see if you are eating less from one week to another. This will help you to see if your food intake is going down, even if you do not feel that you are eating less. If you find that you are eating less, identify the reasons (e.g. diarrhoea, sore mouth, feeling weak) and follow the guidelines provided to increase your food intake.


Meal

Breakfast
7am

Snack
10am

Lunch
1pm

Snack
4pm

Supper
7pm

Bedtime
10pm

Monday


           

Tuesday


           

Wednesday


           

Thursday


           

Friday


           

Saturday


           

Sunday


           



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