OBJECTIVE: To construct an instrument for patients to make notes on swallowing disorders that occur during their daily feeding that cannot be identified upon examination by a speech and hearing therapist. CASE REPORT: The diagnosis of dysphagia is made as a result of clinical, instrumental, and functional exams that include endoscopy and videofluoroscopy of swallowing function. However, the way that patients eat during clinical evaluation and videofluoroscopy is not always the same as the way they usually eat, especially since they know that they are being examined. This variable can influence the results of the evaluations and, consequently, the therapeutic approach. A Word (2007) chart was built that included various factors that patients had to take note of including the type of food and other factors that caused feeding difficulties (saliva, water, juices, yogurts, creams, soups, fruits, vegetables, grains, breads, meats, bran), and the resulting disorder (choking, coughing, drowning sensation, respiratory changes, tiredness or drowsiness after meals). It also included space to note the meal during which the difficulties occurred (breakfast, lunch, snack, and/or dinner). CONCLUSION: A daily diary that is easy to understand, provides relevant data, and is easily accessible should be implemented as part of the routine care and research of swallowing disorders. It can contribute to the understanding of and identify the differential diagnosis, and it may improve the effectiveness of treatment and the therapeutic techniques used.