This Comprehensive Patient Food Symptom Diary has been Published in both English /

Spanish and is a valuable resource for any Healthcare Professional who is providing healthcare services to a patient who has Food Allergies and/or Food Intolerances. This Handout can also be used as a diagnostic tool to help diagnose an unknown Food Allergy and / or unknown Food Intolerance.

This is a 15-page workbook that has enough room for a patient to document 7 notable events with food or beverage that caused them Gastrointestinal discomfort / pain. Each notable event is split between two pages where the patient can document the initial incident and then write a temporary plan to help them keep track of how they want to get help for this particular food / beverage reaction.

This is meant to be issued by Healthcare Professionals, but a Nutrition Enthusiast can also use the PDF digitally or print the 14 pages (minus the title page) to use for their own journey with Food Allergies and/or Food Intolerances. This is also a great resource to use for Telehealth appointments; the PDF can be edited to include the Name / Credentials of the issuer before the electronic appointment with the patient begins.

This Patient Education Handout has practical uses for Inpatient Nutrition Education, Inpatient Discharge Planning, Telehealth Healthcare Appointments, Outpatient Services, Home Enteral Nutrition Therapy (to help troubleshoot feed intolerances with patients who have known Food Allergies and / or Intolerances), and in Pediatric appointments (tool can be given to guardian or parent to help diagnose or track a known Food Allergy / Intolerance)

This PDF file is ready to be printed on standard letter sized paper.

I hope that you find this free Patient Education Handout useful and if you're interested in participating in an encouraging supportive Dietetic Community then please consider becoming a member of The Dietetic Wellness Project. Site membership on Dietetic Wellness is free. If you're already a member and you have used this handout, please leave me a comment!

Sincerely,

Ms. Samantha Michelle Walton, RDN MS Nutrition,

Executive Director & Sole Member Founder/Incorporator

of The Dietetic Wellness Project, & Sole Creator/Designer

of the Official Dietetic Wellness Website for The

Dietetic Wellness Project Nonprofit Corporation

Comprehensive Patient Food Symptom Diary - Electronic or Print Resource - English

Comprehensive Patient Food Symptom Diary - Electronic or Print Resource - Spanish

Legal Disclosure : Free PDF handout for active Healthcare Professionals available at: https://www.dieteticwellness.org/blog under Patient Education Sheet Resources. PDF created in WA State by Ms. Samantha Michelle Walton RDN MS Nutrition 2026. Any reproduction of this handout with the web address and/or name of the author removed will be considered as Intellectual Property Theft and may be punishable through disciplinary action.