Health

Record Chart
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Breakfast

Day 2

Day 3

Day 4

Day 5

Brush Teeth/Shower (BT/S)

Morning Snack

Lunch

Afternoon Snack

Dinner

Evening Snack

Brush Teeth/Shower (BT/S)

Exercise #1
Exercise #2
Sleep (Hours and Times)
Supplements/Herbs/Meds
Symptoms/Complaints

1 Fruit, 2 protein, 1 starch

OR Smoothie Tea, yoghurt,
powder, fruit, & almond milk

Day 1

Protein & Fruit

2 Protein (4-6 oz)

2 Starch (1 sl. Bread)
1 Salad
Yogurt or Cottage Cheese, Fruit
3 Protein (6-8 ounces)
1 Starch (1 sl. ICBread)
1 Fat (any), Veggies
1 Starch
1 Fat

Sitting at Desk or Driving (Hrs)

Additional Notes