Nutrition Tracker

I. Personal Information

Full Name:

Age:


Gender:

Height:


Weight (Starting/Current):

Activity Level:

Goal:

II. Daily Food Intake

Date

Meal Type

Food Item

Serving Size

Estimated Calories

Protein (grams)

Carbohydrates (grams)

Fat (grams)

Fiber (grams)

Sodium (milligrams)

Water Intake (cups/onces/ml)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

How did you feel after this meal?

Did you experience any negative symptoms after eating, and what were they? (e.g. heartburn, headaches)

III. Hydration

Total Water Intake (cups/ounces/ml):

Other Beverages:

Type

Amount

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

IV. Supplements

Item Taken

Dosage

Time Taken

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

V. Exercise/Activity

Type of Exercise/Activity

Duration (minutes)

Intensity (Light/Moderate/Vigorous)

Calories Burned (estimated)

How did you feel during/after the activity?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

VI. Overall Daily Summary/Reflections

Total Calorie Intake:

Total Protein Intake:


Total Carbohydrate Intake:

Total Fat Intake:

How did you feel overall today?

Any challenges faced today?

What went well today?

Notes/Observations

Did you meet your daily goals?


Form Template Instructions

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Strengths:

Comprehensive Coverage:

  • The template covers a wide range of essential nutrition and lifestyle factors, including food intake, hydration, supplements, exercise, and overall well-being.
  • It goes beyond basic calorie tracking to include macronutrient breakdowns, which are crucial for balanced nutrition.

Emphasis on Reflection:

  • The "Overall Daily Summary/Reflections" section encourages users to reflect on their eating habits, identify challenges, and celebrate successes. This promotes self-awareness and behavioral change.

Focus on Well-being:

  • The inclusion of questions about feelings, symptoms, mood, stress, and sleep highlights the connection between nutrition and overall well-being.
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