Nutrition & Eating Online Record
A copy of this submission will be sent to me (Neshama) and a copy will be sent to you as well to keep for tracking purposes.
Date of entry:
Day of the week of entry:
Food and/or beverages eaten:
Food eaten was at:
Where did you eat this?
Activities while eating:
On a scale of 1-5, how HUNGRY were you before eating this food?
Not hungry at all
Any additional thoughts about how HUNGRY you were:
On a scale of 1-5 stars, how much did you ENJOY this food? (1= not at all; 5= enjoyed immensely)
Any additional thoughts about how much and why you did or did not ENJOY this food?
How STRESSED were you when you ate this?
Any additional thoughts about your STRESS while eating this?
Did you have any digestive issues after eating? If so, explain here:
Any final thoughts or "aha" moments?
Enter the message as it's shown
Should be Empty: