| | | | |
-------------------------------------------------------------------------
4. I slept with my window open| 2b| | | | | | |
-------------------------------------------------------------------------
5. I drank six glasses of | | | | | | | |
water between meals | 3| | | | | | |
-------------------------------------------------------------------------
6. I ate no sweets, candy, | | | | | | | |
cake, sweet drinks or ice | | | | | | | |
cream, except as dessert | 4| | | | | | |
-------------------------------------------------------------------------
7. I ate green vegetables | | | | | | | |
or fruit or salad | 5| | | | | | |
-------------------------------------------------------------------------
8. I drank no tea or coffee | 6| | | | | | |
-------------------------------------------------------------------------
9. I drank milk or had milk | | | | | | | |
in some other form | 7| | | | | | |
-------------------------------------------------------------------------
10. I had a bowel movement | 8| | | | | | |
-------------------------------------------------------------------------
11. I washed my hands before | | | | | | | |
eating, and after going to | | | | | | | |
the bathroom | 9| | | | | | |
-------------------------------------------------------------------------
12. I had a bath (at least | | | | | | | |
two a week must be recorded) | 10| | | | | | |
-------------------------------------------------------------------------
13. I brushed my teeth twice | | | | | | | |
during the day | 11| | | | | | |
-------------------------------------------------------------------------
14. I brushed my hair night | | | | | | | |
and morning | 12| | | | | | |
-------------------------------------------------------------------------
15. I shampooe