Exit 3 Day Diet Diary Day One Question Title * 1. Please enter your name Question Title * 2. Breakfast Question Title * 3. Lunch Question Title * 4. Dinner Question Title * 5. Snacks Question Title * 6. Fluid Intake Water Caffeine Alcohol Soft Drinks Other Question Title * 7. Symptoms - Score from 1 (poor) to 5 (excellent) 1 2 3 4 5 Energy Energy 1 Energy 2 Energy 3 Energy 4 Energy 5 Mood Mood 1 Mood 2 Mood 3 Mood 4 Mood 5 Digestive Digestive 1 Digestive 2 Digestive 3 Digestive 4 Digestive 5 Sleep Sleep 1 Sleep 2 Sleep 3 Sleep 4 Sleep 5 Motivation for exercise Motivation for exercise 1 Motivation for exercise 2 Motivation for exercise 3 Motivation for exercise 4 Motivation for exercise 5 Other Symptoms (please specify) Next
