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Preview on US Letter in the Minimal style. The PDF uses exactly the same drawing.

Health

Printable Symptom Diary

A symptom and pain diary to show your doctor: write when it happened, what you noticed, how bad it was on a 0–10 scale, a possible trigger and what helped. A few weeks of rows often say more than trying to remember at the appointment.

Customize This Template Download a free PDF

What you can customize

  • Rows
  • 0–10 scale

Works well in

All page sizes, from Passport to A4

Try it in another style

Start from a preset

  • Symptom diary, 20 rows, US Letter The 0–10 scale at the top and a row per entry. Open in the maker →
  • Migraine and headache diary, US Letter Taller rows, with room to note sleep, food or weather as triggers. Open in the maker →
  • Food and symptom diary, 30 rows, US Letter Many short entries per page, for meals and reactions. Open in the maker →
  • Symptom diary booklet, A5 A small notebook to carry in a bag. Open in the maker →

What’s on the symptom diary

  • Name line in the header.
  • Severity scale: boxes from 0 to 10 in increasing shades, as a reference.
  • Table: date, time, symptom, 0–10, possible trigger and what helped, with 8 to 30 rows per page.

Choose the number of Rows and switch the 0–10 scale on or off in the maker. Fewer rows give more room to write; more rows suit short, frequent entries such as meals and reactions.

Printing it

  1. Use the Letter preset and Download PDF → Reading order. Eight pages last several weeks for most people.
  2. For a pocket diary, choose A5 and Print-ready booklet, print double-sided, fold and staple.
  3. Keep it with your medicines or by your bed, so writing an entry takes a few seconds.

Free sample PDFs

Print at 100% (actual size). Made with the same engine as the maker, so the spacing is exact.

  • Symptom Diary, US Letter (1 page) PDF ↓
  • Symptom Diary, A4 (1 page) PDF ↓

Frequently asked questions

What should I write in a symptom diary?

For each episode, the date and time, what you felt, and its severity from 0 (none) to 10 (worst imaginable). Under Possible trigger note anything that came before, such as a meal, poor sleep, stress or exercise, and under What helped whatever you tried, including rest or medicine.

How do I use the 0–10 scale?

The shaded scale at the top is a reminder of the range. Pick the number that fits how you felt at the time and write it in the narrow 0–10 column. Keep using it the same way so entries can be compared.

How long should I keep the diary?

As long as your doctor or nurse suggests; often a few weeks before an appointment. Bring the sheets with you. The diary records what you notice and does not interpret it.

Can I use it for a child?

Yes. Write the child’s name in the header and note what they tell you or what you see. Turn off the 0–10 scale if a number does not suit them and describe it in words.

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