Food Record Forms

Please click on the age-appropriate Food Record form and print out three copies.

These forms will assist in determining your child’s current nutritional intake. Since eating patterns typically change during the weekend, PEDS, Inc. recommends three consecutive days of food record keeping to include a weekend day, (i.e., Thursday, Friday, Saturday or Sunday, Monday, Tuesday). Please fill out the forms according to the directions. Refer to the age-appropriate Food Records example* for the detailed information necesary to generated an accurate analysis.

*PEDS, Inc does not endorse the listed examples to be used as a dietary recommendation, but are mere examples of what information needs to be recorded to ensure an accurate analysis.

Prior to your appointment, please return these completed food record sheets by mail or FAX them to our office at 636-227-7330.