Sodium Record

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Sodium Record

Use this form to record the sodium content of the foods you eat or drink each day. This record will help you see whether you are getting the prescribed daily amount of sodium in your diet.

Take this record with you when you visit your health professional.

My doctor recommends that I have ___________milligrams (or ______ grams) of sodium in my diet each day.

Meal

Foods and beverages consumed during the meal

Total milligrams (or grams) of sodium in each meal

Breakfast

 

  
Snack

 

  
Lunch

 

  
Snack

 

  
Dinner

 

  
ByHealthwise Staff
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Specialist Medical ReviewerRhonda O'Brien, MS, RD, CDE - Certified Diabetes Educator
Last RevisedJuly 12, 2012



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