Forms

Before your initial meeting with Emily she may request that you download and complete the following forms:

Diet and Health History Questionnaire (Adults)

Diet and Health History Questionnaire (Children and Adolescents)

Food Records

Food records are time consuming and sometimes frustrating. Try your best. Remember this is not a test. It is a simple way to better understand your personal eating habits.

Office Policy Information

Consent To Release

Nutrition Therapy Referral

Emily may also request the following before your initial meeting:

Lab work
Growth chart
Report from other medical professionals

Learn more about services

Tips For Completing A Food Journal

Write as you go

Don’t wait until the end of the day to write down what you eat. This makes it hard to remember exactly what you ate and the portion sizes.

Focus on portions

Try to include common portion sizes such as cups, teaspoons or tablespoons. If you don’t know exact amounts, then estimate. For example, a deli sandwich with about six slices of meat.

Don’t exclude

The goal is to understand how you eat. Remember to write down little bites and extra snacks. Excluded information does not benefit anyone.

Don’t forget drinks

Juice, coffee drinks, alcohol and milk all contain calories. It’s important to include them in your food journal. Also include water. Dehydration may lead to feelings of hunger.

You must have Adobe Reader to read the PDF versions of the publications listed above. You can get a free version of Adobe Reader at www.adobe.com.

Contact Emily Murray, MS, RD, LDN

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