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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

 

   
By Healthwise Staff See additional information
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Rhonda O'Brien, MS, RD, CDE - Certified Diabetes Educator
Current as of July 12, 2012

WebMD Medical Reference from Healthwise

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