Free printable PDF
IC food elimination and reintroduction log, free printable
This IC food elimination and reintroduction log is a printable way to record a food trial over time. It separates a baseline phase from a reintroduction phase, so one food can be added back at a time and symptom notes stay organized.
Updated May 2026. By Intero.
A careful record is the point.
Start with a baseline phase
Use the first page to record a short period of eating from your chosen bladder-friendly list and tracking symptoms.
Reintroduce one food at a time
Use the second page to add back one suspected trigger food at a time. Do not combine multiple new foods in the same trial.
Read repeated patterns, not one day
One hard day does not prove a food is a trigger. Repeated responses are more useful to discuss with a clinician or dietitian.
Use support when you need it
Food restriction can be difficult. Work with a qualified clinician or dietitian when you are unsure.
What is on the form.
Make the pattern easier to see.
- 01Choose the food list or plan you are following before you begin.
- 02Reintroduce one food at a time so the record stays readable.
- 03Leave time between trials if symptoms change.
- 04Bring the log to a clinician or dietitian if you want help interpreting it.
Common questions.
- Is this medical advice?
- No. This is a tracking worksheet. It does not diagnose, treat, or tell you what diet to follow.
- Should I do an elimination diet without support?
- If you are unsure, pregnant, underweight, managing an eating disorder history, or have other medical concerns, talk with a qualified clinician or dietitian first.
- Is the form really free?
- Yes. The PDF is free to download.
Download the PDF, or keep tracking in Intero.
The worksheet is free. The Intero app gives you a private place to keep tracking on iPhone and review patterns over time.
Sources used
These sources informed the structure and language of this tracking worksheet. The form is informational and does not replace medical advice.