Instructions for 3-Day Food Record

1. Please indicate the date and the day of the week that you are recalling at the top of the food record.
Record two weekdays and one weekend day for best results. Please use a day that was/is fairly typical
for you in terms of your normal eating habits.
2. Record each food and beverage you consumed on a separate line. When eating combination foods
(e.g., sandwich, lasagna, stew, casserole, etc.) please separate the food/dish into its individual
components as much as possible.
3. Record food and beverages in reasonably exact amounts: liquids in cups or fluid ounces; grains,
cereals, pasta in cups (please indicate if the measure is dry or cooked); meats, fish, chicken in ounces,
fruits & vegetables in cups.
4. Please specify if the food was consumed raw or cooked (and indicate the type of cooking method
used). Also indicate if it was prepared from fresh, canned or frozen products.
5. Please indicate how the food was prepared; e.g., fried, baked, boiled, grilled, steamed, etc.
6.

List brand names or sources wherever possible. If the food item is unusual (fat-free, international food,
supplement) please enclose a label if possible.

7. For fruits, potatoes, chicken etc. please indicate if the skin was removed before consumption
8. Please be sure to indicate if dairy products, (i.e., milk, cheese, yogurt, etc.) was whole, low-fat (1%,
2%), non-fat (skim), etc.
9. Be sure to include all the little extras (e.g., sauces, gravies, candy, etc.)
Provide any other information you think might be helpful.

3-Day Food Record Day 1

Name: _______________________________

Date: ________

Day of Week: M T
(circle one)
Age: ________ Height: ___________ Weight: ___________ Activity Level*: ______

Th F Sa Su

*Activity level: 1. Sedentary: Very inactive, sometimes under the care of another person. 2. Lightly Active: Most office workers and professionals.
Equals 8 hours of sleep, 16 hours of sitting/standing of which 3 hours is light (e.g. walking, laundry) and 1 hour of moderate (e.g. tennis, brisk walk,
aerobics) activity. 3. Moderately Active: Most persons in light industry, building trades, child care providers, active students (approximately 1.5-2
hours of moderate activity per day). 4. Very Active: Full time athletes, mine or steel workers, army recruits. 5. Extremely Active: Lumberjacks, active
construction workers, heavy manual digging, coal miners.

Please record as accurately as possible all food and beverages you consumed for one day. Please give as many
details as possible regarding the food/beverage item. Please list all supplements consumed including sports
foods/beverages, vitamins, minerals, herbs etc. When eating out specify the restaurant and when you use
convenience foods please specify the brands.
Time
8:00 am
9:00

Food/Beverage
Example:
Example:

cinnamon raisin bagel

weight training

Brand or Source
Lenders
1 hour

Type of Preparation
Toasted
moderate intensity

Amount
1 ea. (3 oz)

3-Day Food Record Day 2

Date: ________

Day of Week: M T W Th F Sa Su
(circle one)
Weight: ___________ Activity Level*: ______
*Activity level: 1. Sedentary: Very inactive, sometimes under the care of another person. 2. Lightly Active: Most office workers and professionals.
Equals 8 hours of sleep, 16 hours of sitting/standing of which 3 hours is light (e.g. walking, laundry) and 1 hour of moderate (e.g. tennis, brisk walk,
aerobics) activity. 3. Moderately Active: Most persons in light industry, building trades, child care providers, active students (approximately 1.5-2
hours of moderate activity per day). 4. Very Active: Full time athletes, mine or steel workers, army recruits. 5. Extremely Active: Lumberjacks, active
construction workers, heavy manual digging, coal miners.

Please record as accurately as possible all food and beverages you consumed for one day. Please give as many
details as possible regarding the food/beverage item. Please list all supplements consumed including sports
foods/beverages, vitamins, minerals, herbs etc. When eating out specify the restaurant and when you use
convenience foods please specify the brands.
Time
8:00 am
9:00

Food/Beverage
Example:
Example:

cinnamon raisin bagel

weight training

Brand or Source
Lenders
1 hour

Type of Preparation
Toasted
moderate intensity

Amount
1 ea. (3 oz)

3-Day Food Record Day 3

Date: ________

Day of Week: M T W Th F Sa Su
(circle one)
Weight: ___________ Activity Level*: ______
*Activity level: 1. Sedentary: Very inactive, sometimes under the care of another person. 2. Lightly Active: Most office workers and professionals.
Equals 8 hours of sleep, 16 hours of sitting/standing of which 3 hours is light (e.g. walking, laundry) and 1 hour of moderate (e.g. tennis, brisk walk,
aerobics) activity. 3. Moderately Active: Most persons in light industry, building trades, child care providers, active students (approximately 1.5-2
hours of moderate activity per day). 4. Very Active: Full time athletes, mine or steel workers, army recruits. 5. Extremely Active: Lumberjacks, active
construction workers, heavy manual digging, coal miners.

Please record as accurately as possible all food and beverages you consumed for one day. Please give as many
details as possible regarding the food/beverage item. Please list all supplements consumed including sports
foods/beverages, vitamins, minerals, herbs etc. When eating out specify the restaurant and when you use
convenience foods please specify the brands.
Time
8:00 am
9:00

Food/Beverage
Example:
Example:

cinnamon raisin bagel

weight training

Brand or Source
Lenders
1 hour

Type of Preparation
Toasted
moderate intensity

Amount
1 ea. (3 oz)