The image displays a simple, black and white illustration of a circular form with a central hole. The form is outlined with a thick black line and contains text fields for "DATE," "TIME," "WEIGHT," and "LENGTH." The text fields are empty, and the form appears to be a template for recording information. The form is set against a plain white background, which contrasts with the black lines and text, making the form the focal point of the image. The overall style of the image is minimalistic and functional, suggesting that the form is likely used for practical purposes, such as tracking weight and length measurements over time.