Daily Weight Loss Journal Form Weight loss journaling is a proven method to achieve your weight loss goals and effective lifestyle changes. Weight Loss Journal Form Date * First Name * Last Name * Email * Breakfast Food Eaten Food Breakdown Protein Starch Vegetables Fruits Fat Protein Amount Starch Amount Vegetables Amount Fruit Amount Fat Amount Morning Snack Food Eaten Food Breakdown Protein Starch Vegetables Fruits Fat Protein Amount Starch Amount Vegetables Amount Fruit Amount Fat Amount Lunch Food Eaten Food Breakdown Protein Starch Vegetables Fruits Fat Protein Amount Starch Amount Vegetables Amount Fruit Amount Fat Amount Afternoon Snack Food Eaten Food Breakdown Protein Starch Vegetables Fruits Fat Protein Amount Starch Amount Vegetables Amount Fruit Amount Fat Amount Dinner Food Eaten Food Breakdown Protein Starch Vegetables Fruits Fat Protein Amount Starch Amount Vegetables Amount Fruit Amount Fat Amount Evening Snack Food Eaten Food Breakdown Protein Starch Vegetables Fruits Fat Protein Amount Starch Amount Vegetables Amount Fruit Amount Fat Amount Overall How much water did you drink? Did you take your vitamins? Yes No How many supplements? What type of exercise did you do and for how long? Feelings/Comments - What happened today? (Big and small achievements, obstacles, pitfalls, discoveries, frustrations, slips, victories, etc.) reCAPTCHA Submit Δ
