Food Log for ______________
Date
Food
Presentation
(circle the appropriate selection)
o
o
o
whole
chopped
pureed
liquid
o
o
o
whole
chopped
pureed
liquid
o
o
o
whole
chopped
pureed
liquid
o
o
o
whole
chopped
pureed
liquid
o
o
o
whole
chopped
pureed
liquid
o
o
o
whole
chopped
pureed
liquid
o
o
o
o
o
o
o
o
o
o
whole
chopped
pureed
liquid
Quantity
(amount offered
and consumed)
Page: ___________
Tolerance
(circle the appropriate selection)
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
visual
touched
smelled
licked
took a bite
visual
touched
smelled
licked
took a bite
visual
touched
smelled
licked
took a bite
visual
touched
smelled
licked
took a bite
visual
touched
smelled
licked
took a bite
visual
touched
smelled
licked
took a bite
visual
touched
smelled
licked
took a bite
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
chewed
swallowed
spit out
pushed away
cried
chewed
swallowed
spit out
pushed away
cried
chewed
swallowed
spit out
pushed away
cried
chewed
swallowed
spit out
pushed away
cried
chewed
swallowed
spit out
pushed away
cried
chewed
swallowed
spit out
pushed away
cried
chewed
swallowed
spit out
pushed away
cried
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