Please complete this form before your first appointment and bring it with you.
Food Diary
Patients may be asked to complete a food diary which provides a snapshot of your diet. This information provides an indicator of possible deficiencies and excesses. A food diary can also assist to identify if dietary intake is associated with symptoms.
Record a minimum of 5 days including a weekend day.
Fill in this diary with as much information you can. Include the brand names, serving sizes if possible.
Example
Lunch - 2 slices Burgen wholegrain & oats bread, 4 slices tomato, 2 slices Kraft cheddar cheese, spinach, avocado, chicken breast (40g). 1 glass water
Dinner - Lamb curry - coconut milk based, sweet potato, green beans, lamb (takeaway) 1 serve basmati rice. 2 glasses red wine. 1 serve lemon pie with cream. 1 coffee with milk 1 sugar.
Your practitioner may also request a record of symptoms be kept. This can be included on the food diary by noting * when these symptoms occur.
Record a minimum of 5 days including a weekend day.
Fill in this diary with as much information you can. Include the brand names, serving sizes if possible.
Example
Lunch - 2 slices Burgen wholegrain & oats bread, 4 slices tomato, 2 slices Kraft cheddar cheese, spinach, avocado, chicken breast (40g). 1 glass water
Dinner - Lamb curry - coconut milk based, sweet potato, green beans, lamb (takeaway) 1 serve basmati rice. 2 glasses red wine. 1 serve lemon pie with cream. 1 coffee with milk 1 sugar.
Your practitioner may also request a record of symptoms be kept. This can be included on the food diary by noting * when these symptoms occur.
Child Sleep Diary
Parents will often indicate that a child has difficulty going to sleep, staying asleep or does not sleep enough.
This Sleep diary is a tool to track your childs sleep for further discussion with your practitioner.
This Sleep diary is a tool to track your childs sleep for further discussion with your practitioner.