Awareness Journal Directions
Thank you for taking your time to fill out an Awareness Journal. I believe this is a necessary first step on the road to better health. Please print off or copy as many pages as needed for a one week period of time. The Journal must be filled out with complete honesty, or the information will not be useful. It is not something that is graded or judged. This is a tool for you to understand yourself and your eating patterns better. Sometimes we know we want to change, however we are not sure how or what we need to change. An Awareness Journal can bring to light areas to start making new habits in.
Your Awareness Journal must be completed prior to your first appointment, so please set your appointment 7 days out. If you have questions leave me a message at 1-800-384-6766 and I will get back with you. Thank you!
Here is an example of how to fill out the Journal:
|
Date |
Time |
Food/Beverage |
Amount |
Where |
Why |
Feeling before ate |
Feeling after ate |
|
9/9 2007 Time Awake Time sleep |
|
Cup of coffee Cup of coffee and donut Potato Chips, Mountain Dew Broiled cod with steamed mix vegetables with
extra butter & salad |
8 oz 16 oz / 3 Large snack size bag, 42 0z soda Fist size fish, 2 cups veg. |
Kitchen Counter Work Meeting Car while driving Apple- Bee’s |
Tired, like reading paper with coffee It was available and I forgot to eat
breakfast I was starving, didn’t have time for lunch Spend time with Husband |
Neutral, just woke up Bored Anxious to get home, stressed from
confrontation at work Little uptight, restaurant packed |
Awake, but slow Little tired, Stressed Took a short nap before husband got home Went to bed |
Expression/word samples:
Why: hungry, breakfast time, lunch, dinner, snack time, food was available, social event, taste good, habit, free food, smelled good, sample…..
Feeling Before: uncomfortable, “out-of-control”, lonely, stressed, threatened, fine, dizzy, tired, hungry, sad, depressed, happy, social, angry, frustrated, bored, unappreciated, afraid…..
Feeling After: tired, sick, gas, stomach hurts, cramps, lazy, sad, stressed, angry, too full, betrayed, alive, active, energetic, normal…..