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DAILY SELF MONITORING FORM

WEEK:
DAY 1:

Eat correctly?

YES / NO

Further comments if ate badly, did exercise etc:

Cravings?

YES / NO

Energy levels?

HIGH / NORMAL / LOW

Exercise?

YES / NO

SUMMARY:

DID WELL / OKAY / DID BADLY

DAY 2:

Eat correctly?

YES / NO

Further comments if ate badly, did exercise etc:

Cravings?

YES / NO

Energy levels?

HIGH / NORMAL / LOW

Exercise?

YES / NO

SUMMARY:

DID WELL / OKAY / DID BADLY

DAY 3:

Eat correctly?

YES / NO

Further comments if ate badly, did exercise etc:

Cravings?

YES / NO

Energy levels?

HIGH / NORMAL / LOW

Exercise?

YES / NO

SUMMARY:

DID WELL / OKAY / DID BADLY

DAY 4:

Eat correctly?

YES / NO

Further comments if ate badly, did exercise etc:

Cravings?

YES / NO

Energy levels?

HIGH / NORMAL / LOW

Exercise?

YES / NO

SUMMARY:

DID WELL / OKAY / DID BADLY

DAY 5:

Eat correctly?

YES / NO

Further comments if ate badly, did exercise etc:

Cravings?

YES / NO

Energy levels?

HIGH / NORMAL / LOW

Exercise?

YES / NO

SUMMARY:

DID WELL / OKAY / DID BADLY

DAY 6:

Eat correctly?

YES / NO

Further comments if ate badly, did exercise etc:

Cravings?

YES / NO

Energy levels?

HIGH / NORMAL / LOW

Exercise?

YES / NO

SUMMARY:

DID WELL / OKAY / DID BADLY

DAY 7:

Eat correctly?

YES / NO

Further comments if ate badly, did exercise etc:

Cravings?

YES / NO

Energy levels?

HIGH / NORMAL / LOW

Exercise?

YES / NO

SUMMARY:

DID WELL / OKAY / DID BADLY