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This page contains printable checklists, diaries, charts, plans, and self-tests to help you keep track of your health. Use the sleep diary to find out more about what affects your sleep patterns. Print off a form that can help you monitor your blood sugar. Take a quiz to get a better idea of how well you cope with stress. Or print the menu plan and grocery list and post it on your refrigerator to help you make better food choices.

To get started tracking your health, click on a form below.

Checklists

• Charting your basal body temperature: Celsius (What is a PDF document?)
• Charting your basal body temperature: Fahrenheit (What is a PDF document?)
• Diabetes: Checklist for identifying low-vision aids for daily activities (What is a PDF document?)
• Hospice evaluation checklist (What is a PDF document?)
• Hospital discharge checklist (What is a PDF document?)
• Nursery equipment safety checklist (What is a PDF document?)
• Postpartum depression checklist (What is a PDF document?)
• Post-traumatic stress disorder (PTSD) checklist (What is a PDF document?)
• Preventing falls at home (What is a PDF document?)
• Rosacea diary checklist (What is a PDF document?)
• Vertigo: Checklist for personal considerations (What is a PDF document?)
• Vertigo: Checklist for the bathroom and kitchen (What is a PDF document?)
• Vertigo: Checklist for the home environment (What is a PDF document?)

Diaries, Charts, and Records

• Asthma diary template (What is a PDF document?)
• Blood pressure: Home log (What is a PDF document?)
• Cancer medication record (What is a PDF document?)
• Cancer pain control diary (What is a PDF document?)
• Childhood immunization record (What is a PDF document?)
• Chronic pain diary (What is a PDF document?)
• Cirrhosis: Sodium record (What is a PDF document?)
• Comparing heart-healthy diets (What is a PDF document?)
• Diabetes: Feelings diary (What is a PDF document?)
• Diabetes: Food record form (list the foods you eat) (What is a PDF document?)
• Diabetes: Food record form (record your portions) (What is a PDF document?)
• Diabetes: High blood sugar record for a child (What is a PDF document?)
• Diabetes: High blood sugar record for an adult (What is a PDF document?)
• Diabetes: Home blood sugar diary (What is a PDF document?)
• Diabetes: Low blood sugar level record for a child (What is a PDF document?)
• Diabetes: Low blood sugar level record for an adult (What is a PDF document?)
• Headache diary (What is a PDF document?)
• Healthy eating: Food record form (What is a PDF document?)
• Heartburn symptom record (What is a PDF document?)
• Heart failure: Sodium record (What is a PDF document?)
• Heart failure: Symptom record (What is a PDF document?)
• Incontinence: Voiding log (bladder record) (What is a PDF document?)
• Menstrual diary to monitor premenstrual symptoms (What is a PDF document?)
• Rosacea diary checklist (What is a PDF document?)
• Sleep diary (What is a PDF document?)
• Symptom diary (What is a PDF document?)

Making the Most of Your Appointments

• Appointment for a new problem (What is a PDF document?)
• Daily medicine schedule (What is a PDF document?)
• Family medical history (What is a PDF document?)
• First appointment (What is a PDF document?)
• Follow-up appointment (What is a PDF document?)
• Master list of medicines (What is a PDF document?)
• Medical test information (What is a PDF document?)
• Medications list (What is a PDF document?)
• New medicine information (What is a PDF document?)
• Regular checkup for a child (What is a PDF document?)
• Regular checkup for a lifelong condition (What is a PDF document?)
• Special treatment information (What is a PDF document?)
• Surgery information (What is a PDF document?)

Managing Diabetes

• Blood sugar testing times form (What is a PDF document?)
• Diabetes activity log (What is a PDF document?)
• Feelings diary (What is a PDF document?)
• Food list card (What is a PDF document?)
• Food record form (list the foods you eat) (What is a PDF document?)
• Food record form (record your portions) (What is a PDF document?)
• High blood sugar record for a child (What is a PDF document?)
• High blood sugar record for an adult (What is a PDF document?)
• Home blood sugar diary (What is a PDF document?)
• Low blood sugar level record for a child (What is a PDF document?)
• Low blood sugar level record for an adult (What is a PDF document?)
• Low-vision aids for daily activities checklist (What is a PDF document?)
• Meal plan form for carbohydrate counting (What is a PDF document?)
• Menu ideas form (What is a PDF document?)

Plans

• ADHD: Family rules form (What is a PDF document?)
• ADHD: Form for establishing a routine (What is a PDF document?)
• ADHD: Sample school plan (What is a PDF document?)
• ADHD: Treatment plan record (What is a PDF document?)
• Alcohol use: Form for identifying reasons to cut down on or stop (What is a PDF document?)
• Alcohol use: Plan to stop drinking (What is a PDF document?)
• Asthma action plan (What is a PDF document?)
• Exercise planning sheet (What is a PDF document?)
• Meal planning: menu and grocery list (What is a PDF document?)
• Personal action plan (What is a PDF document?)
• Planning to be more active when you have chronic disease (What is a PDF document?)
• 10 principles of recovery (What is a PDF document?)

Screenings and Self-Tests

• Assess your tobacco use (What is a PDF document?)
• Drug abuse screening test (What is a PDF document?)
• Smokers self-test (What is a PDF document?)
• Stress: Coping strategies (What is a PDF document?)
• Substance abuse self-test (What is a PDF document?)

Vaccines and Immunizations

• Adults ages 19 years and older (What is a PDF document?)
• Anthrax (What is a PDF document?)
• Chickenpox (Varicella) (What is a PDF document?)
• Childhood immunization record (What is a PDF document?)
• Children ages 4 months to 18 years who missed getting some immunizations (What is a PDF document?)
• Children ages newborn to 6 years (What is a PDF document?)
• Children ages 7 to 18 years (What is a PDF document?)
• Diphtheria/Tetanus/Pertussis (DTaP) (What is a PDF document?)
• Haemophilus Influenzae Type b (Hib) (What is a PDF document?)
• Hepatitis A (What is a PDF document?)
• Hepatitis B (What is a PDF document?)
• Human Papillomavirus (HPV) (What is a PDF document?)
• Inactivated H1N1 (H1N1 flu shot) (What is a PDF document?)
• Inactivated Influenza (flu shot) (What is a PDF document?)
• Japanese Encephalitis (What is a PDF document?)
• Live, Intranasal H1N1 (nasal spray H1N1 flu vaccine) (What is a PDF document?)
• Live, Intranasal Influenza (nasal spray flu vaccine) (What is a PDF document?)
• Measles/Mumps/Rubella (MMR) (What is a PDF document?)
• Meningococcal (What is a PDF document?)
• Pneumococcal Conjugate (PCV) (What is a PDF document?)
• Pneumococcal Polysaccharide (PPSV) (What is a PDF document?)
• Polio (IPV) (What is a PDF document?)
• Rabies (What is a PDF document?)
• Rotavirus (What is a PDF document?)
• Shingles (What is a PDF document?)
• Smallpox (Vaccinia) (What is a PDF document?)
• Tetanus/Diphtheria (Td) and Tetanus/Diphtheria/Pertussis (Tdap) (What is a PDF document?)
• Typhoid (What is a PDF document?)
• Yellow Fever (What is a PDF document?)

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Author:	Andrija Barker-McCurry Marianne Flagg	Last Updated: May 27, 2009
Medical Review:	Adam Husney, MD - Family Medicine
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