SCORE BOARD© TREATMENT CENTER

Patients Name: __________________________________________________________________

Phone: _________________________________________________________________________

Report For Week Of: _____________________________________________________________

For each day of the week, indicate with a check mark weather the enuretic was wet or dry. If wet, please write in the number of times and the size of the spots. If dry, place a star in the "Dry" box for that day.

	SUN	MON	TUE	WED	THU	FRI	SAT
WET - Number of times, spot size (small, medium, large)
DRY - You win a star!

Comments: ________________________________________________________________________

_________________________________________________________________________________

DO NOT VARY FROM THIS DIET FOR THE FIRST WEEK....THEN REFER TO THE DIET IN THE KIT. FOR EACH DAY INDICATE BELOW THE FOODS WHERE THE CHILD HAS CHEATED.

You can not eat or drink the following:	SUN	MON	TUE	WED	THU	FRI	SAT
Milk/Yogart
Other Dairy Products
Coffee, Tea, Iced Tea
Soft Drinks, Sodas
Kool-Aid, Colored Drinks
Fast Foods, Wendys, Pizza, McDonalds, etc.
Chocolate
Sugar (pre-sweetened cereal cake, cookies)
Chips, Spicy Foods
Preservatives, MSG (monosodiumglutamate)

PLEASE, understand that these are temporary food corrections listed below. You cannot have milk or milk products of any kind. DO NOT drink or cook with milk...Use Silk Milk or Soy Milk…Eggs are not dairy so you may eat eggs. Buy non-dairy products in the larger grocery chains and health food stores and on the web. Sweeten with Splenda. Use organic and natural foods and drinks. When you have been dry for (3) three weeks, you can slowly add these foods to your diet. Which is important, a few weeks of restraining from your favorite "diet" or a "dry bed"? Think about an over-night trip without the worry of wetting the bed.

Comments: ________________________________________________________________________

Return completed form each week to:

If you have any questions or concerns, please send us an email at info@hargitthousefoundation.com or by visiting the website at www.hargitthousefoundation.com.