The FooD journal

The Food Journal is used to assess your daily nutrition patterns and health. We will ask you a series of questions to learn about how you're doing with your nutrition so we can help you reach your goals.

Confidentiality statement

We will respect your privacy. No information about who you are will be given to anyone or be published without your permission, unless required by law. For example if you have an illness that could spread to others, if you or someone else talks about suicide (killing themselves), or if the court orders us to give them the questionnaire data. The data produced from this questionnaire will be stored in a secure location. Only members of the Wells Group Team will have access to the data. This could include Wells Group Integrated Support Team members. Published program results will not reveal your identity but will report group mean and other group statistical data.

A Few Questions about your current NUTRITION patterns...

Answer the questions to the best of your ability.

Name *
Name
Date
Date
What did you eat and at what time?
What did you eat and at what time?
What did you eat and at what time?
What did you eat and at what time?
What did you eat and at what time?
Number of cups of water I drank today.
(e.g. Size, colour, undigested food seen, consistency...)
(e.g. gas, bloating, burping, indigestion)
Type Duration
How are doing with your nutrition? Anything you want us to know?