Lactose Intolerance Dietary Review
Personal Information
Name
Age
Symptoms
List symptoms experienced after consuming lactose-containing foods:
Symptom onset (minutes/hours after eating):
Current Diet
How often do you consume dairy products?
Describe typical meals including dairy sources:
List foods you avoid because of lactose intolerance:
Alternatives & Substitutes
List any lactose-free alternatives or substitutions used:
Supplementation
Are you using lactase supplements or digestive aids? If so, specify:
Concerns & Goals
Describe any challenges with avoiding lactose:
What are your dietary or health goals?
Additional Notes