Diary of Symptoms

Topic Overview

You can help your health professional diagnose and treat your condition by being prepared to answer questions about your symptoms. Since some symptoms are difficult to describe, it is helpful to write down information about your symptoms as you experience them during your daily activities.

While waiting for your appointment, keep a diary of your symptoms. This form may help.

Describe the symptom for which you are keeping this diary:

Day 1 2 3 4 5 6 7
Time of day the symptom starts              
Time of day the symptom bothers you the most              
Does the symptom come and go during the day?              
Is the symptom affected by any of the following:
  • Activity
  • Rest
  • Prescription or nonprescription medications (name and time)
  • Stress
  • Alcohol or caffeinated drinks (number and time)
  • Smoking or the use of other tobacco products
What other symptoms do you have:
Rate how you felt today:
1 - Great
2 - Okay
3 - Not good
4 - Bad
Other information about your symptom:


Author Bets Davis, MFA
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Harold S. Nelson, MD - Allergy and Immunology
Last Updated July 2, 2009

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