Name _____________________________ Date________________________
In terms of Oriental Health, it is important to find foods you like that
keep you in balance and healthy. They are generally the ones that will make
you vital and energetic. In order to begin finding the foods that go well
with you, it is helpful to list the foods you eat each day for 7 days. The
list doesn't need to be exact and you can include on it at the end
foods you may be avoiding, but really enjoy. We should look at the whole
picture to make your plan an enjoyable and natural process rather than one
of rigid discipline. Please also include the drinks that you take and the
time you have each meal.
DAY 1: _____________
Breakfast_______________________________________________Time_______
Lunch__________________________________________________Time_______
Dinner__________________________________________________Time_______
Snacks taken during the day ___________________________________________
__________________________________________________________________
DAY 2: __________________________
Breakfast_______________________________________________Time_______
Lunch__________________________________________________Time_______
Dinner__________________________________________________Time_______
Snacks taken during the day ___________________________________________
__________________________________________________________________
DAY 3: _____________
Breakfast_______________________________________________Time_______
Lunch__________________________________________________Time_______
Dinner__________________________________________________Time_______
Snacks taken during the day ___________________________________________
__________________________________________________________________
DAY 4: _____________
Breakfast_______________________________________________Time_______
Lunch__________________________________________________Time_______
Dinner__________________________________________________Time_______
Snacks taken during the day ___________________________________________
__________________________________________________________________
DAY 5: __________________________
Breakfast_______________________________________________Time_______
Lunch__________________________________________________Time_______
Dinner__________________________________________________Time_______
Snacks taken during the day ___________________________________________
__________________________________________________________________
DAY 6: _____________
Breakfast_______________________________________________Time_______
Lunch__________________________________________________Time_______
Dinner__________________________________________________Time_______
Snacks taken during the day ___________________________________________
__________________________________________________________________
DAY 7: _____________
Breakfast_______________________________________________Time_______
Lunch__________________________________________________Time_______
Dinner__________________________________________________Time_______
Snacks taken during the day ___________________________________________
__________________________________________________________________
Please list any foods you like or dislike, and any food cravings you experience.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Do you have any other questions regarding your diet?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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