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May 24, 2013
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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:

Day1234567
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:

Related Information

Credits

AuthorBets Davis, MFA
EditorSusan Van Houten, RN, BSN, MBA
Associate EditorPat Truman, MATC
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerHarold S. Nelson, MD - Allergy and Immunology
Last UpdatedJuly 2, 2009

eMedicineHealth Medical Reference from Healthwise

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