OBJECTIVE: To construct an instrument for patients to make notes on their swallowing disorders that occur in daily feeding, which cannot be identified in speech and hearing therapist's exams. CASE REPORT: The diagnosis of dysphagia occurs from the results of clinical, instrumental and functional exams, such as endoscopy and videofluoroscopy of swallowing. However, the way that patients eat in the clinical evaluation and videofluoroscopy is not always the same as they eat into their usual meals, especially knowing that they are being examined. This variable can influence the results of the evaluations and, consequently, in the therapeutic approach. A Word (2007) chart was build, composed by various aspects for patients to take note, including the type of food that caused feeding difficulties; among it saliva, water, juices, yogurts, creams, soups, fruits, vegetables, grains, breads, meats and bran; and which was the disorder: choking, coughing, drowning, respiratory changes, tiredness or drowsiness after meals. It also included space for notes on the meal in which the difficulties occurred; breakfast, lunch, snack and/or dinner. Conclusion: A daily diary, easy to understand, with relevant data and accessible viewing, should be implemented in routine care and research of swallowing disorders. It can contribute to understand and identify the differential diagnosis, as it may improve the effectiveness of treatment and therapeutic techniques, by the enrichment of speech and hearing researches.