PERSONAL METRICS FORM for (name) _____________________________________

    DATE _________________________________________


BODILY DIMENSION MEASUREMENTS 

  HEIGHT    Feet _______   Inches _______  Notes  ___________________________

  WEIGHT    Pounds  _______   Notes  _________________________________

  WAIST SIZE    Inches   _______      Notes  _________________________________

   Thigh _____   Calf _____   Hips _____   Neck _____   Biceps _____ 


BODILY FUNCTION MEASUREMENTS 

  BLOOD PRESSURE    Systolic  _______    Diastolic  _______    Notes  _______

  PULSE RATE    Beats per Minute  _______    Notes  _________________________


  BLOOD GLUCOSE (mg/dL)   Before Breatfast _______   Before Lunch _______


  Before Dinner _______   Before Bedtime Snack ______   Fasting _______


  Other Time _______   Notes  ______________________________      


DIETARY INTAKE

 TIME  _______   CALORIES  _____   FAT GRAMS  _____  CARB GRAMS ____

    PROTEIN GRAMS _____  FIBER GRAMS  _____  COMMENTS ____________________ 

 TIME  _______   CALORIES  _____   FAT GRAMS  _____  CARB GRAMS ____

    PROTEIN GRAMS _____  FIBER GRAMS  _____  COMMENTS ____________________ 

 TIME  _______   CALORIES  _____   FAT GRAMS  _____  CARB GRAMS ____

    PROTEIN GRAMS _____  FIBER GRAMS  _____  COMMENTS ____________________ 

 TIME  _______   CALORIES  _____   FAT GRAMS  _____  CARB GRAMS ____

    PROTEIN GRAMS _____  FIBER GRAMS  _____  COMMENTS ____________________ 

 TIME  _______   CALORIES  _____   FAT GRAMS  _____  CARB GRAMS ____

    PROTEIN GRAMS _____  FIBER GRAMS  _____  COMMENTS ____________________ 

 TIME  _______   CALORIES  _____   FAT GRAMS  _____  CARB GRAMS ____

    PROTEIN GRAMS _____  FIBER GRAMS  _____  COMMENTS ____________________ 

 TIME  _______   CALORIES  _____   FAT GRAMS  _____  CARB GRAMS ____

    PROTEIN GRAMS _____  FIBER GRAMS  _____  COMMENTS ____________________ 


 DAILY TOTAL:   CALORIES  _____   FAT GRAMS  _____  CARB GRAMS ____

    PROTEIN GRAMS _____  FIBER GRAMS  _____  COMMENTS ____________________ 


EXERCIZE

  Walking - Minutes/Miles __________  Comments ___________________

  Jogging - Minutes/Miles __________  Comments ___________________

  Running - Minutes/Miles __________  Comments ___________________

  Swimming - Minutes/Miles __________  Comments ___________________

  Biking - Minutes/Miles __________  Comments ___________________

  Other __________________________________________________________
     
  Calesthenics (Repetitions)

     Situps _____   Pushups _____   Pull-Ups _____  Kneee Bends _____

     Other  ________________________________________________________

  
   Personal Metrics Form from http://MyPersonalMetrics.com
   For details, explanations, and links, please see website, above.
   a service of http://LoveAllPeople.org, Rev. Bill McGinnis - Director
   PUBLIC DOMAIN