Daily Diet Tracker Form

Personal Diet & Wellness Tracker Form

👤 Personal Information

Name:
Age:
Gender:	Male Female Other
Height (cm):
Weight (kg):

🥗 Dietary Preferences & Restrictions

Food Preference:	Vegetarian Non-Vegetarian Eggetarian Vegan
Food Allergies:	Milk Nuts Egg Fish Soy Gluten

💊 Medical History

Medical Conditions Diabetes Thyroid High Blood Pressure PCOS/PCOD High Cholesterol None

⚙️ Lifestyle Patterns

Sleep Duration (hrs):
Water Intake (litres/day):
Physical Activity:	Sedentary Moderate Active

🎯 Health & Nutrition Goals

Goals:

Weight Loss Muscle Gain General Wellness Increase Energy

📝 Daily Diet Log

Meal	Food Items	Calories
Breakfast
Lunch
Evening Snacks
Dinner
Total Calories

About the Developer

Archa Biju

This form was developed by Archa Biju, a Software Engineer. It is designed for personal health tracking and to aid dietitians in creating customized plans.