Optimal Health & Fitness Nutrition and Exercise Form


Name:

Date:

                                                NUTRITION

Meals/Snacks:


Time:

What did you eat?

Time:

What did you eat?

Time:

What did you eat?

Time:

What did you eat?

Time:

What did you eat?

Time:

What did you eat?


Food Group Totals:

KEY

Grains: 1 oz equivalent = 1 slice bread, 1 cup dry cereal, or 1/2 cup cooked rice, pasta, or cereal

Milk: 1 cup equivalent = 1 1/2 oz cheese

Meats: 1 oz equivalent = 1 oz meat, poultry or fish, 1 egg, 1 T peanut butter, 1/2 oz nuts, or 1/4 cup dry beans

Water: 1 liter = 34 oz

Grains (oz equivalents):

Vegetables (cups):

Fruits (cups):

Dairies (cups):

Meats (oz equivalents):

Water (oz):

Nutrition Comments:

                                                EXERCISE

Strength:

Cardio:

Stretching:

Exercise Comments: 




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