Digestive Episode Log 📋
Track your digestive episodes with this compassionate, easy-to-use form designed for your well-being.
What's happening?
GI Symptoms (select all that apply)
*
Nausea
Bloating
Gas
Right-side Pain
Upper Abdominal Pain
Diarrhea
Constipation
Urgency
Reflux / Heartburn
Loss of Appetite
Pain level right now
*
No pain
0
1
2
3
4
5
6
7
8
9
Worst possible
10
0 is No pain, 10 is Worst possible
Pain Location
*
Upper Right
Upper Center
Lower Right
Lower Left
Whole Abdomen
Back / Shoulder
No Pain
When did this start?
*
Hour Minutes
AM
PM
AM/PM Option
What did you eat before this?
Last Meal Before Event
*
Fat Content of Last Meal
*
Very Low
Low
Moderate
High
Very High
Minutes After Eating
*
Please Select
Under 15 min
15-30 min
30-60 min
1-2 hours
2-4 hours
4+ hours
Unrelated to food
More detail
Stool type if relevant (Bristol Scale)
*
Please Select
1 - Hard lumps
2 - Lumpy sausage
3 - Cracked sausage
4 - Smooth sausage (ideal)
5 - Soft blobs
6 - Fluffy pieces
7 - Liquid
N/A
Does this feel like a gallbladder attack?
*
Yes
No
Duration of Episode
*
Please Select
Still ongoing
Under 30 min
30-60 min
1-2 hours
2-4 hours
4+ hours
How stressed were you when this started?
*
1
2
3
4
5
Hormone Context (select all that apply)
*
Pre-period
During period
Post-period
Mid-cycle
Unknown
What helped?
Medications Taken
Resolution Method
Notes
Log this episode 📋
Should be Empty: