Anxiety and medicine log
A one-week sheet for worry, panic attacks, sleep, caffeine, situations faced or avoided, medicines, and side effects, with space for questions. Fill it in each day and bring it to your next appointment.Download PDFThe PDF can be filled in on a computer or printed and written by hand.
Printable weekly log
Weekly anxiety and medicine log
- Name
- Week starting
- Filled in by
Scroll the table sideways to see all 7 days. The PDF and the printed sheet fit the whole week on one page.
| Each day | Mon | Tue | Wed | Thu | Fri | Sat | Sun |
|---|---|---|---|---|---|---|---|
| Worry or anxiety level0 = calm, 10 = worst | / 10 | / 10 | / 10 | / 10 | / 10 | / 10 | / 10 |
| Panic attacksHow many, and how long | |||||||
| SleepHours last night | hrs | hrs | hrs | hrs | hrs | hrs | hrs |
| Caffeine and alcoholWhat, and how much | |||||||
| Situations faced or avoidedWhat happened | |||||||
| Medicines takenName, dose, time | |||||||
| Missed or late doseWhich one, and why | YesNo | YesNo | YesNo | YesNo | YesNo | YesNo | YesNo |
| Side effectsWhat, and how bad | |||||||
| Thoughts of death or self-harmYes or no. If yes, call or text 988 | YesNo | YesNo | YesNo | YesNo | YesNo | YesNo | YesNo |
If you have thoughts of death or of hurting yourself on any day, do not wait for your appointment. Call or text 988 or chat at 988lifeline.org to reach the 988 Suicide & Crisis Lifeline, free and confidential, 24/7. In a life-threatening situation, call 911.
My medicines
Include over-the-counter medicines, herbal remedies, vitamins, and supplements.
| Medicine | Dose | When I take it | What it is for | Started |
|---|---|---|---|---|
Questions for my next appointment
Write them down as they come up during the week.
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Why keep a log
Tips for tracking and bringing notes
Notes make the visit easier
A provider may ask when your symptoms began, how long they have lasted, how often they happen, and how they affect your life. Writing this down ahead of time helps.
National Institute of Mental Health · Generalized anxiety disorder
Be specific
Describe all your symptoms, when they started, how severe they are, and how often they happen. Share any major stress or recent life changes too.
National Institute of Mental Health · Tips for talking with a health care provider
List every medicine
Tell your provider about all the medicines you take, including over-the-counter drugs, herbal remedies, vitamins, and supplements.
National Institute of Mental Health · Tips for talking with a health care provider
Track caffeine and sleep
Cutting back on caffeine and getting enough sleep can reduce anxiety symptoms alongside treatment. A log shows whether changes help.
National Institute of Mental Health · Generalized anxiety disorder
Give medicines time, and note changes
The full effect of an anxiety medicine builds over 2 weeks or more, and some people feel more anxious, agitated, or jittery at first. Daily notes make early changes easier to see and report.
National Institute for Health and Care Excellence · Social anxiety disorder (CG159) recommendations
Write down questions as they come up
Make a list of what you want to discuss and any questions or concerns, so you remember them during the appointment.
National Institute of Mental Health · Tips for talking with a health care provider
Bring someone if you like
A family member or friend can come for support, help take notes, and help remember what the provider said.
National Institute of Mental Health · Tips for talking with a health care provider
Crisis wording follows the National Institute of Mental Health medications page.
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