New clients must submit 3 consecutive days worth of Journals.

NOTE: you may use the form provided below, or the PDF document attached below. If you use the form, you will have to submit a new form each day. Once you press "enter/return" the journal will be submitted. Please take care not to press the "enter/return" button prematurely.


Write down the types of foods you eat at each meal. Record ANYTHING and EVERYTHING that passes over your lips each day. This includes snacks and the “little nibbles” you think are insignificant. Be as specific as possible! Include sauces, gravies, and condiments.


Keep your food journal forms with you all day and write down everything you eat and/or drink, no matter how small or large the serving. Even if you eat a small piece of candy, a whole bag or cookies, a handful of nuts/seeds, a soda, or juice, write down ANYTHING you consume.


Many experience intestinal gas, bloating, belching and other digestive pangs after eating. Your practitioner needs to be informed of these digestive symptoms. Also, if you experience energy and/or mood changes after eating, this is a sign that you may be eating an imbalanced diet (i.e. too many carbohydrates, too little fat and protein). Please record any digestive, energy, and/or mood changes as these are helpful clues for your practitioner.


If we are eliminating too often, this can be a sign of food allergies/intolerances. If we are eliminating too slowly, this may be an indication of a sluggish digestive tract. Please record when you have a bowel movement each day and also include whether or not you see undigested food in your stools, and/or if your stools are poorly formed (flat, loose), and/or if your stools are light in color. These are important elimination symptoms that are helpful to your practitioner.


Write down what you are eating and drinking immediately. Don’t depend on your memory at the end of the day to help you fill in the blanks. Record what you eat and drink throughout the day.


If you eat a whole pizza, WRITE IT DOWN! Include what was on the pizza (dough, cheese, meat, veggies, etc., etc.) and also include what you ate with it (soda, salad, pasta, bread sticks, and so on). Please include the ounces of beverages and cup measurements of food as often as possible. For example, if you write down that you had a bottle of water, please state the ounces of water in that bottle. If you cook at home, please indicate what type of fat/oil you used (olive, coconut, butter). Include all foods cooked and eaten along with main meals, as well as beverages and dessert, if any.


You have nothing to gain by trying to look good or to please your practitioner when completing your food journal. Your practitioner can be much more helpful to you if he/she knows EXACTLY what you are consuming and/or craving. No one is judging you, so help your practitioner serve you better by being completely honest about your eating habits.

Food Journal
Name *
Not any mood changes throughout your day
Note any digestive changes (examples: nausea, stomach pains, burping etc.)
Please list any bowel movements you had during the day, and note the number of hours you slept the previous night. Make notes of consistency of bowel movements (hard, soft, loose, etc.) and quality of sleep (slept through the night, woke up, woke feeling rested or tired etc.)

If you would like to print and fill in paper copies of your Daily journals, you may choose between one of the two options below. Simply right-click, then download/save the document as a PDF. You may then print pages off and fill them in by hand. You can scan and email completed Journals to:

NOTE: Journals must be submitted a minimum of 3-days prior to your consultation.