Free template · PDF · US Letter
Free Printable Acid Reflux Diary (PDF)
| Date | Time | Meal (2h before) | Position | Severity (0–10) | Duration | Notes |
|---|---|---|---|---|---|---|
How to use this sheet
- Print the PDF — one page covers about three weeks of episodes.
- After each significant episode, log the date and time while it's fresh — memory fades quickly.
- In the Meal column, write what you ate and drank in the two hours before symptoms started.
- Note body position when symptoms started: upright, recently reclined, or lying flat — position is often underreported and highly relevant.
- After two to three weeks, look for patterns: certain foods, late-night meals, or specific positions. Bring the log to your doctor.
Questions
Is this diary really free?
Yes. The PDF is free to download and print — no sign-up, no email.
What foods commonly trigger acid reflux?
Commonly discussed triggers include coffee, citrus, tomato-based foods, alcohol, spicy food, chocolate, and fatty meals — but individual responses vary considerably. That's exactly why a personal diary is more actionable than a universal list.
Does lying down after meals really make reflux worse?
It's one of the most consistently reported aggravating factors — gravity helps keep stomach acid down when you're upright. The diary includes a position column precisely because it's a variable many people don't think to track until they see it in their own data.
Is there an app version of this diary?
Yes — RefluxLog for iPhone logs episodes, meals, and positions and shows patterns over time. The core app is free, no account needed, and your data stays on your device.
Want the log to analyze itself?
RefluxLog for iPhone tracks the same things in seconds and shows you the patterns — free core, no account, and everything stays on your device.