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Height:
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DayofWeek:
Date:
Weight:
140
MT
(circle one)
Activity Level*:
1-
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sa
su
*Activity level:
1. Sedentary: Very inactivz, sometimes under the care of another peraon. 2. Lightly Active: Most office workers and professionals.
Eguals 8 hours of sleep, 16 hours of sittinglstanding of which 3 hours ls light (e.9. walking, laundry) and t hour of moderate {e.g. tennis, bisk walk,
aercbics) activity. 3. Moderately Aetive: Most persons in light industry, building trades, child carc prcviders, active students (approximately 1.*2
hours of moderate activity per day). 4. Very Active: Full time athletes, mine or steel workers, army recruits, 5. Extremety Active: Lumberjacks, active
construction workera, heavy manual digging, coal miners.
Please record as accurately as possible all food and beverages you consumed for one day. Please give as many
details as possible regarding the food/beverage item. Please list all supplements consumed including sports
foods/beverages, vitamins, minerals, herbs etc. When eating out specify the restaurant and when you use
convenience foods please specify the brands.
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details as possible regarding the foodibeverage item. Please list all supplements consumed including sports
foods/beverages, vitamins, minerals, herbs etc. When eating out specify the restaurant and when you use
convenience foods please specify the brands.
Time
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Brand or Source
Type ol Preparation
8:00 am
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details as possible regarding the food/beverage item. Please list all supplements consumed including sports
foods/beverages, vitamins, minerals, herbs etc. When eating out specify the restaurant and when you use
convenience foods please specify the brands.
Time
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