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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

 

    
By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer W. Thomas London, MD - Hepatology
Last Revised January 17, 2012

Last Revised: January 17, 2012

Author: Healthwise Staff

Medical Review: Adam Husney, MD - Family Medicine & W. Thomas London, MD - Hepatology

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