7 day food diary – food and feelings

Name_____________________________ Date________

Monday to Sunday – include supplements & drinks

Breakfast________________________________________________________

M. Tea__________________________________________________________

Lunch___________________________________________________________

A. Tea___________________________________________________________

Dinner___________________________________________________________

Supper__________________________________________________________

Sleeping pattern

Do you have problems going to sleep? Yes/No Time you go to bed......

Do you wake during the night? Yes/No Time you wake up.......

Do you wake feeling refreshed? Yes/No

Basal Temp ..................(under the arm first thing in the morning before arising)