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IC food elimination and reintroduction log, free printable
Use this IC food elimination and reintroduction log to track a food trial over time. It separates the baseline phase from the reintroduction phase so one food can be added back at a time.
Updated May 2026. By Intero.
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How to use the food trial log
Start with a baseline phase
Use the first page to track a short period of eating from your chosen bladder-friendly list.
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 rough symptom 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
- Baseline phase tracker
- Reintroduction tracker, one food per row
- Symptom notes before and after reintroduction
- Space for questions or clinician notes
How to use it
- 01Choose the food list or plan you are following before you begin.
- 02Reintroduce one food at a time so the log 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.
Sources used
These sources informed the structure and language of this tracking worksheet. The form is informational and does not replace medical advice.