Name:_________________________
In the space below, write down: Everything you eat or drink and at what time you eat or drink it. How your food was prepared, such as broiled, baked, fried, or uncooked. Things you add to food, such as butter, salad dressing, or artificial      sweetener.	The amount of each food you ate. The amount of carbohydrates you ate, in grams, as indicated in      the Nutrition Facts label on the food package. All of your physical activity, such as brisk walking, swimming, or      prenatal exercise class. How much time you spent doing physical activity.

Date	Time	Food, How It Was Prepared, and Things You Added To It	Amount	Carbohydrates	Physical Activity	Time Spent Doing Physical Activity