Daily Weight Log

 

DAILY WEIGHT LOG

INSTRUCTIONS:    

1.) Weigh   y ourself   f irst   t hing   e ach   m orning,   b efore   y ou   h ave   a nything   t o   e at   o r   d rink.    

2.) Before   y ou   w eigh   y ourself,   e mpty   y our   b ladder.   W ear   t he   s ame   l evel   o f   c lothing   ( less   i s   b etter)   e ach  

day.      

3.) Record   y our   w eight   i n   t his   l og   a nd   t rack   h ow   y ou   f eel.   B ring   t his   l og   t o   y our   c linic   a ppointments.    

 

MY   T ARGET   W EIGHT   I S:   _ _____   ( lbs.)   _ _____   ( kg)  

 

DATE:  

DAY   O F   W EEK  

WEIGHT  

Heart   F ailure   Z one:   G reen,   Y ellow,   R ed  

 

Monday  

 

 

_______________  

Tuesday  

 

 

Wednesday  

 

 

Thursday  

 

 

Friday  

 

 

Saturday  

 

 

Sunday  

 

 

 

DATE:  

DAY   O F   W EEK  

WEIGHT  

Heart   F ailure   Z one:   G reen,   Y ellow,   R ed  

 

Monday  

 

 

_______________  

Tuesday  

 

 

Wednesday  

 

 

Thursday  

 

 

Friday  

 

 

Saturday  

 

 

Sunday  

 

 

 

DATE:  

DAY   O F   W EEK  

WEIGHT  

Heart   F ailure   Z one:   G reen,   Y ellow,   R ed  

 

Monday  

 

 

_______________  

Tuesday  

 

 

Wednesday  

 

 

Thursday  

 

 

Friday  

 

 

Saturday  

 

 

Sunday  

 

 

 

DATE:  

DAY   O F   W EEK  

WEIGHT  

Heart   F ailure   Z one:   G reen,   Y ellow,   R ed  

 

Monday  

 

 

_______________  

Tuesday  

 

 

Wednesday  

 

 

Thursday  

 

 

Friday  

 

 

Saturday  

 

 

Sunday  

 

 

 

Call   y our   h ealth   c are   p rovider   i f   y ou   g ain   4   l bs.   ( 2   k g)   o ver   2   d ays   i n   a   r ow,    

or   i f   y ou   g ain   5   l bs.   ( 2.5   k g)   i n   o ne   w eek.