Daily Symptoms Tracker
Take an active and effective role in your own personal health by tracking your symptoms and their intensity. Having a record of your symptoms ensures your doctor has an accurate set of data to provide you the best care.
Symptom:
List what you are experiencing.
Time of Day:
Morning: 5 A.M. - 12 P.M.
Afternoon: 12 P.M. - 5 P.M.
Evening: 5 P.M. - 9 P.M.
Night: 9 P.M. - 5 A.M.
Severity:
1 - Minimal; pain is hardly noticeable
2 - Mild; notice pain, but does not interfere with activities
3 - Uncomfortable; pain is sometimes distracting
4 - Moderate; pain is distracting, but can still do normal activities
5 - Distracting; pain interrupts some activities
6 - Distressing; pain is hard to ignore and avoiding usual activities
7 - Unmanageable; cannot focus because of pain, pain prevents doing daily activities
8 - Intense; pain is awful, unable to do anything
9 - Severe; pain is unbearable, unable to do anything
10 - Unable to Move; pain is as bad as it could be
Was Medication Taken to Mitigate Symptom:
Did you take a painkiller or other medication to alleviate the symptom? If you did, what did you take and how much?
Notes:
Any additional notes you might have such as how long your symptoms lasted throughout the day or potential cause.