Conscious Health & Wellness - Miriam Pineles, L.Ac., Dipl. OM - 347-878-9619

Food Diary


Please keep a log of everything you ingest for 3 days. This will serve to help me better guide you on the foods and supplements that are best for your particular constitution. Please don’t worry about listing "bad" foods. I am not here to judge you! Listing snacks and "junk food" items will help me learn the foods you crave and what you eat when you are hungry.

Please note the following in the box below or write down on paper and bring with you to your next visit:

  1. Day and time you are eating
  2. The contents and amount you are eating. For Example: 2 slices whole wheat bread with 3 slices of smoked turkey breast and 1 tsp of hummus. 6oz water, 8oz coffee, 2 sugars.
  3. How you felt before and after eating. For example: "I was not satisfied and therefore ate dessert", "Had heartburn and took Tums", "Felt bloated all day".
  4. List all vitamins and medications and the time you take them.

Click here to download and print a food diary worksheet.



Licensed Acupuncturist, Board Certified in Chinese Medicine