Free template · PDF · US Letter
Free Printable Heartburn Trigger Log (PDF)
| Date | Foods & drinks (flag suspects) | Last meal time | Symptoms (Y/N) | Time of symptoms | Severity (0–10) | Notes |
|---|---|---|---|---|---|---|
How to use this sheet
- Print the PDF and keep it somewhere visible — near where you eat or on the fridge.
- Each day, note what you ate and drank, marking any common GERD suspects with a circle or asterisk.
- Record the time of your last meal — eating within two to three hours of lying down is a well-documented aggravator.
- If symptoms occur, note the time and rate severity from 0–10.
- After two to three weeks, look for which foods, times, or combinations appear before your symptomatic days. Bring the log to your doctor.
Questions
Is this log really free?
Yes. The PDF is free to download and print — no sign-up, no email.
Is heartburn the same as acid reflux?
They're related but not identical. Acid reflux is the physical event — stomach acid moving into the esophagus. Heartburn is the burning sensation it often causes. GERD is a chronic condition defined by frequent, troublesome reflux. A diary tracks the symptom; diagnosis is your doctor's job.
Should I stop coffee and spicy food immediately?
That's a conversation with your doctor. A diary helps you find your actual triggers rather than eliminating everything based on general advice — some people tolerate coffee fine; others have triggers that aren't on any standard list.
Is there an app version?
Yes — RefluxLog for iPhone logs episodes, meals, and patterns and shows which factors appear most often before your worse days. Core is free, no account needed, 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.