* Self Monitoring Form

DAILY SELF MONITORING FORM
WEEK: DAY 1:
Eat correctly?	YES / NO	Further comments if ate badly, did exercise etc:
Cravings?	YES / NO
Energy levels?	HIGH / NORMAL / LOW
Exercise?	YES / NO
SUMMARY:	DID WELL / OKAY / DID BADLY

DAY 2:
Eat correctly?	YES / NO	Further comments if ate badly, did exercise etc:
Cravings?	YES / NO
Energy levels?	HIGH / NORMAL / LOW
Exercise?	YES / NO
SUMMARY:	DID WELL / OKAY / DID BADLY

DAY 3:
Eat correctly?	YES / NO	Further comments if ate badly, did exercise etc:
Cravings?	YES / NO
Energy levels?	HIGH / NORMAL / LOW
Exercise?	YES / NO
SUMMARY:	DID WELL / OKAY / DID BADLY

DAY 4:
Eat correctly?	YES / NO	Further comments if ate badly, did exercise etc:
Cravings?	YES / NO
Energy levels?	HIGH / NORMAL / LOW
Exercise?	YES / NO
SUMMARY:	DID WELL / OKAY / DID BADLY

DAY 5:
Eat correctly?	YES / NO	Further comments if ate badly, did exercise etc:
Cravings?	YES / NO
Energy levels?	HIGH / NORMAL / LOW
Exercise?	YES / NO
SUMMARY:	DID WELL / OKAY / DID BADLY

DAY 6:
Eat correctly?	YES / NO	Further comments if ate badly, did exercise etc:
Cravings?	YES / NO
Energy levels?	HIGH / NORMAL / LOW
Exercise?	YES / NO
SUMMARY:	DID WELL / OKAY / DID BADLY

DAY 7:
Eat correctly?	YES / NO	Further comments if ate badly, did exercise etc:
Cravings?	YES / NO
Energy levels?	HIGH / NORMAL / LOW
Exercise?	YES / NO
SUMMARY:	DID WELL / OKAY / DID BADLY