Directions:  List ALL foods, drinks, snacks, supplements, and medications you take throughout the day.  This includes if you drink a soda pop in-between meals, or have a drink of water, snacks of any size, a sucker or cough drop, etc.  Any snacks or drinks, extra meals, etc eaten between meals should be written in the "snacks" column.  Please be descriptive as to amount you eat/drink and what time, including drinking water or beverages.  Please describe the nature of your food, for example:  Homogenized Whole Milk, Fresh Broccoli, Cooked Peas, Fresh Apple, Snickers Candy Bar, Diet Pepsi, Cooked Frozen Mixed Vegetables, Roasted Salted Peanuts, Raw Cashews, etc.   Submit this form daily for the number of days requested by your educator or practitioner.  Thank you.



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