4. Food and Symptom Diary Template
Filled in once a day, this diary is your treatment's primary clinical tool; consistent entries give your team the data they need to judge progress.
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This diary is your primary clinical tool during FMT treatment. Complete one entry per day. Consistent, honest recording – even on difficult days – provides the data your clinical team needs to evaluate your progress and adjust your treatment plan.
Daily Entry Format
Date: _______ Phase: 0 / 1 / 2 / 3 Day of treatment: _______
Stool Record
Number of bowel movements today: _______
Bristol Stool Scale type (circle): 1 – 2 – 3 – 4 – 5 – 6 – 7
Bristol Scale reference: Type 1–2 = hard/constipated | Type 3–4 = normal | Type 5–6 = loose | Type 7 = watery diarrhoea
Blood in stool: Yes / No | Mucus in stool: Yes / No
Symptom Scores (0 = none, 10 = severe)
Abdominal pain: ___ | Bloating: ___ | Nausea: ___ | Fatigue: ___ | Urgency: ___
Other symptoms (describe): _______________________________
Temperature
Morning temperature: ___°C | Evening temperature (if measured): ___°C
Food Record (brief)
Breakfast: ________________________________________________
Lunch: ____________________________________________________
Dinner: ___________________________________________________
Fibre-rich foods today (tick): Vegetables □ Legumes □ Wholegrains □ Fruit □ Nuts/seeds □
Fermented foods today: ____________________________________
Approximate water intake: ___ litres
Medications and Supplements Today
(List all medications, supplements, and FMT capsules taken today)
Sleep and Stress
Hours of sleep last night: ___ | Sleep quality (0–10): ___
Stress level today (0–10): ___ | Exercise today: Yes / No | Type/duration: ___________
Notes / Observations
Weekly Summary (complete at end of each week)
Overall week rating (0–10): ___
Most significant change this week: ___________________________
Questions or concerns for clinical team: ______________________
Note: If you experience fever above 38.5°C, blood in stool, severe pain, or signs of dehydration, contact your clinical team immediately (see Chapter II.6 for full warning sign reference).