Food Diary

Food Diary

When & Where

Time & Location

0% Complete

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What was I doing?
Who was I with?

14% Complete

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What I ate & drank

28% Complete

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Binge?

Y or N

42% Complete

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Vomit or Laxatives?

V or L

57% Complete

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Exercise?

What did I do? How long for? When?

71% Complete

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Triggers
Thoughts
Feelings

What started it? Reason for binge?
What went through my mind?
Physical sensations & emotions?

85% Complete

Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Eating Disorders to learn more about Eating Disorders and to get in touch with one of iTherapy's counselors.

When & Where? What was I doing?
Who was I with?
What I ate or drank Binge? Vomit or Laxatives? Exercise? Triggers
Thoughts
Feelings

Answer Question to Complete Worksheet

Answer Question to Complete Worksheet

Answer Question to Complete Worksheet

Answer Question to Complete Worksheet

Answer Question to Complete Worksheet

Answer Question to Complete Worksheet

Answer Question to Complete Worksheet

When & Where?

Answer Question to Complete Worksheet

What was I doing?
Who was I with?

Answer Question to Complete Worksheet

What I ate & drank

Answer Question to Complete Worksheet

Binge?

Answer Question to Complete Worksheet

Vomit or Laxatives?

Answer Question to Complete Worksheet

Exercise?

Answer Question to Complete Worksheet

Triggers
Thoughts
Feelings

Answer Question to Complete Worksheet


© Carol Vivyan 2009, permission to use for therapy purposes.

100% Complete

Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Pain Management to learn more about Pain Management and to get in touch with one of iTherapy's counselors.
Thanks to www.getselfhelp.co.uk for this template.