Daily Weight Log
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1DAILY WEIGHT LOG
Name:
Month:
Year:
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
1. Record your weight
every day.
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
2. Call your doctor right
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
away if you gain 3-5
pounds in 1 week
3. If a symptom is new
or gets worse, write
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
it on the log, and
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
call your doctor
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
right away.
4. Place a “x” in the
box to note when
you’ve called your
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
doctor.
5. Take this log to your
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
doctor appointments.
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
WEIGHT
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
SYMPTOMS:
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
CALLED DOCTOR
LSCVAMC 0214 8/10/05
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Parent category: Life