Form is registered by M.D. Smith, 1000 Monte Sano Blvd, Huntsville, AL 35801
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|      Diet Disk Food Logging Form for week of _________________  19_______   |
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|  Sunday      |Cal |   Monday     |Cal |   Tuesday    |Cal | Wednesday  |Cal |
|--------------|----|--------------|----|--------------|----|------------|----|
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|--------------|----|--------------|----|--------------|----|------------|----|
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|--------------|----|--------------|----|--------------|----|------------|----|
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|-----------------------------------------------------------------------------|
|Daily totals|      |            |      |            |      |          |      |
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+-----------------------------------------------------------------------------+
|   Thursday   |Cal |   Friday     |Cal |  Saturday    |Cal |  TOTALS    |Cal |
|--------------|----|--------------|----|--------------|----|------------|----|
|              |    |              |    |              |    | for week   |    |
|              |    |              |    |              |    | BREAKFAST  |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|--------------|----|--------------|----|--------------|----|------------|----|
|              |    |              |    |              |    | for week   |    |
|              |    |              |    |              |    | LUNCH      |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|--------------|----|--------------|----|--------------|----|------------|----|
|              |    |              |    |              |    | for week   |    |
|              |    |              |    |              |    | DINNER     |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|              |    |              |    |              |    |            |    |
|--------------|----|--------------|----|--------------|----|-----------------|
|Daily totals|      |            |      |            |      |                 |
+------------------------------------------------------------Grand Total------+