with Waitrose
Confidential
Preparing for your
Living Well consultation
Thank you for booking a consultation with our Living Well team. To enable our food and nutrition experts
to give you the best and most personalised advice during your session, please complete this three-day food
diary and return it to us at least one week before. Download and print the PDF, fill it in and either scan and
email to [email protected] or return in a sealed envelope to the Welcome Desk at Waitrose Bagshot.
• Please circle your answers below or provide the information requested •
Name
Gender
Male
Age
Female
How many people are there in your household?
Adults:
Children aged under 4:
Children aged 4 - 11:
Children aged 12+:
Do you have any special dietary requirements, such as a food allergy, or cholesterol reduction?
No
Yes
Please give details:
What advice would you most like to get from the session?
Nutrition advice
OR
How would you describe your cooking ability?
Recipe ideas
What type of ingredients do you mostly use for cooking, eg all raw; a mix of jars and packets; ready meals?
How long do you usually spend preparing meals? Please give an approximate time and usual method of preparation
Breakfast
Lunch
Dinner
What gets in the way of you eating more healthily?
What are your biggest challenges you would like to address with the Waitrose food and nutrition experts?
with Waitrose
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Food diary: day 1
Food diary: day 2
• Please record everything you eat and drink, no matter how small,
throughout the day. Try to do this as soon as possible as it’s easy to forget!
• Please record everything you eat and drink, no matter how small,
throughout the day. Try to do this as soon as possible as it’s easy to forget!
• Complete three days. They don’t have to be consecutive days,
but choose at least one weekday and one weekend day.
• Complete three days. They don’t have to be consecutive days,
but choose at least one weekday and one weekend day.
• The more detail you are able to give (eg white or wholemeal bread or pasta; home-made
or shop-bought; quantity/portion size), the more beneficial your consultation will be.
• The more detail you are able to give (eg white or wholemeal bread or pasta; home-made
or shop-bought; quantity/portion size), the more beneficial your consultation will be.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
(circle day)
Example
Time
Food and drink consumed
Thoughts/triggers
eg, where was I?
4pm
3 dried apricots
Low energy, needed a
mid-afternoon boost
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
(circle day)
Example
Morning
Morning
Lunch
Lunch
Afternoon
Afternoon
Dinner
Dinner
Time
Food and drink consumed
Thoughts/triggers
eg, where was I?
4pm
3 dried apricots
Low energy, needed a
mid-afternoon boost
with Waitrose
Food diary: day 3
• Please record everything you eat and drink, no matter how small,
throughout the day. Try to do this as soon as possible as it’s easy to forget!
• Complete three days. They don’t have to be consecutive days,
but choose at least one weekday and one weekend day.
• The more detail you are able to give (eg white or wholemeal bread or pasta; home-made
or shop-bought; quantity/portion size), the more beneficial your consultation will be.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
(circle day)
Example
Morning
Lunch
Afternoon
Dinner
Time
Food and drink consumed
Thoughts/triggers
eg, where was I?
4pm
3 dried apricots
Low energy, needed a
mid-afternoon boost