Daily Journal
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Drinks (all day)
Quantity in Cups
Water
Coffee
Tea
Soda
Juice
Description of physical activity
Meal
Breakfast
Lunch
Snack
Dinner
Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Food / Size / Quantity
From Where
Home
Away from Home
Feelings/Emotions/Cravings
Alone/With Others
Alone
With Others
Meal
Breakfast
Lunch
Snack
Dinner
Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Food / Size / Quantity
From Where
Home
Away from Home
Feelings/Emotions/Cravings
Alone/With Others
Alone
With Others
Meal
Breakfast
Lunch
Snack
Dinner
Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Food / Size / Quantity
From Where
Home
Away from Home
Feelings/Emotions/Cravings
Alone/With Others
Alone
With Others
Meal
Breakfast
Lunch
Snack
Dinner
Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Food / Size / Quantity
From Where
Home
Away from Home
Feelings/Emotions/Cravings
Alone/With Others
Alone
With Others
Submit
Should be Empty: