Bowel Movement Activity Form
*Please start this form 1 week prior to Agile capsule test*
Bowel Movements Before Agile Capsule
Date Time
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Bowel Movements After Agile Capsule
Date Time(s) Capsule
Noticed? Y/N
Day 1
Day 2