Health Tracking Forms and Checklists

This page contains printable checklists, diaries, charts, plans, and self-tests to help you keep track of your health. Use the sleep diary to find out more about what affects your sleep patterns. Print off a form that can help you monitor your blood sugar. Take a quiz to get a better idea of how well you cope with stress. Or print the menu plan and grocery list and post it on your refrigerator to help you make better food choices.

To get started tracking your health, click on a form below.

Checklists

• Evaluating Hospice Programs (What is a Reference PDF Opens New Window document?)
• Hospital Discharge Checklist (What is a Reference PDF Opens New Window document?)
• Preventing Falls at Home (What is a Reference PDF Opens New Window document?)
• Using Low-Vision Aids at Home (What is a Reference PDF Opens New Window document?)
• Vertigo: Checklist for Personal Considerations (What is a Reference PDF Opens New Window document?)
• Vertigo: Checklist for the Bathroom and Kitchen (What is a Reference PDF Opens New Window document?)
• Vertigo: Checklist for the Home Environment (What is a Reference PDF Opens New Window document?)
• 10 Principles of Recovery (What is a Reference PDF Opens New Window document?)

Diaries, Charts, and Records

• Alcohol Use: Identifying Reasons to Cut Down On or Stop (What is a Reference PDF Opens New Window document?)
• Asthma Diary (What is a Reference PDF Opens New Window document?)
• Blood Pressure: Home Log (What is a Reference PDF Opens New Window document?)
• Childhood Immunization Record (What is a Reference PDF Opens New Window document?)
• Cirrhosis: Sodium Record (What is a Reference PDF Opens New Window document?)
• Comparing Heart-Healthy Diets (What is a Reference PDF Opens New Window document?)
• Diabetes: Tracking My Feelings (What is a Reference PDF Opens New Window document?)
• Diabetes: Tracking My Foods and Blood Sugar Levels (What is a Reference PDF Opens New Window document?)
• Diabetes: Home Blood Sugar Diary (What is a Reference PDF Opens New Window document?)
• Diabetes in Adults: Record of My High Blood Sugar Emergency (What is a Reference PDF Opens New Window document?)
• Diabetes in Adults: Record of My Low Blood Sugar Problems (What is a Reference PDF Opens New Window document?)
• Diabetes in Children: Record of My Child's High or Low Blood Sugar Problems (What is a Reference PDF Opens New Window document?)
• Headache Diary (What is a Reference PDF Opens New Window document?)
• Healthy Eating: Tracking My Servings From Each Food Group (What is a Reference PDF Opens New Window document?)
• Heartburn Symptom Record (What is a Reference PDF Opens New Window document?)
• Heart Failure: Track Your Weight, Food, and Sodium (What is a Reference PDF Opens New Window document?)
• Heart Failure: Symptom Record (What is a Reference PDF Opens New Window document?)
• Incontinence: Voiding Log (Bladder Record) (What is a Reference PDF Opens New Window document?)
• Menstrual Diary to Monitor Premenstrual Symptoms (What is a Reference PDF Opens New Window document?)
• Pain Control Diary (What is a Reference PDF Opens New Window document?)
• Pain Diary (What is a Reference PDF Opens New Window document?)
• Physical Activity Log (What is a Reference PDF Opens New Window document?)
• Record of My Medicines and How Well They Work (What is a Reference PDF Opens New Window document?)
• Rosacea Diary (What is a Reference PDF Opens New Window document?)
• Sleep Diary (What is a Reference PDF Opens New Window document?)
• Symptom Diary (What is a Reference PDF Opens New Window document?)
• Women's Fertility: Charting My Basal Body Temperature (Celsius) (What is a Reference PDF Opens New Window document?)
• Women's Fertility: Charting My Basal Body Temperature (Fahrenheit) (What is a Reference PDF Opens New Window document?)

Making the Most of Your Appointments

• Appointment for a New Problem (What is a Reference PDF Opens New Window document?)
• Daily Medicine Schedule (What is a Reference PDF Opens New Window document?)
• Family Medical History Record (What is a Reference PDF Opens New Window document?)
• First Appointment (What is a Reference PDF Opens New Window document?)
• Follow-Up Appointment (What is a Reference PDF Opens New Window document?)
• Master List of Medicines (What is a Reference PDF Opens New Window document?)
• Medical Tests: Questions to Ask the Doctor (What is a Reference PDF Opens New Window document?)
• New Medicines: Questions to Ask the Doctor (What is a Reference PDF Opens New Window document?)
• Other Treatment: Questions to Ask the Doctor (What is a Reference PDF Opens New Window document?)
• Regular Checkup for a Child (What is a Reference PDF Opens New Window document?)
• Regular Checkup for a Lifelong Condition (What is a Reference PDF Opens New Window document?)
• Surgery: Questions to Ask the Doctor (What is a Reference PDF Opens New Window document?)

Managing Diabetes

• Blood Sugar Testing Times Form (What is a Reference PDF Opens New Window document?)
• Food List (What is a Reference PDF Opens New Window document?)
• Home Blood Sugar Diary (What is a Reference PDF Opens New Window document?)
• Menu Planning Form (What is a Reference PDF Opens New Window document?)
• Form for Carbohydrate Counting (What is a Reference PDF Opens New Window document?)
• Physical Activity Log (What is a Reference PDF Opens New Window document?)
• Record of My Child's High or Low Blood Sugar Problems (What is a Reference PDF Opens New Window document?)
• Record of My High Blood Sugar Emergency (What is a Reference PDF Opens New Window document?)
• Record of My Low Blood Sugar Problems (What is a Reference PDF Opens New Window document?)
• Tracking My Feelings About Diabetes (What is a Reference PDF Opens New Window document?)
• Tracking My Foods and Blood Sugar Levels (What is a Reference PDF Opens New Window document?)
• Using Low-Vision Aids at Home (What is a Reference PDF Opens New Window document?)

Plans

• ADHD: Form for Establishing a Routine (What is a Reference PDF Opens New Window document?)
• ADHD: Sample School Plan (What is a Reference PDF Opens New Window document?)
• ADHD: Treatment Plan Record (What is a Reference PDF Opens New Window document?)
• Alcohol Use: Plan to Stop Drinking (What is a Reference PDF Opens New Window document?)
• Asthma Action Plan (What is a Reference PDF Opens New Window document?)
• Exercise Planning Form (What is a Reference PDF Opens New Window document?)
• Meal Planning: Menu and Grocery List (What is a Reference PDF Opens New Window document?)
• Parenting: Family Rules Form (What is a Reference PDF Opens New Window document?)
• Planning to Be More Active When You Have Chronic Disease (What is a Reference PDF Opens New Window document?)
• Pregnancy: My Birth Plan (What is a Reference PDF Opens New Window document?)
• Setting Goals: Personal Action Plan (What is a Reference PDF Opens New Window document?)

Screenings and Self-Tests

• Assess Your Drug Use (What is a Reference PDF Opens New Window document?)
• Assess Your Substance Use (What is a Reference PDF Opens New Window document?)
• Assess Your Tobacco Use (What is a Reference PDF Opens New Window document?)
• My Reasons to Quit Smoking (What is a Reference PDF Opens New Window document?)
• Post-Traumatic Stress Disorder (PTSD) Assessment (What is a Reference PDF Opens New Window document?)
• Self-Test For Anxiety (What is a Reference PDF Opens New Window document?)
• Stress: How Do You Cope? (What is a Reference PDF Opens New Window document?)

Vaccines and Immunizations

• Adenovirus Vaccine (What is a Reference PDF Opens New Window document?)
• Adult Immunization Schedule (What is a Reference PDF Opens New Window document?)
• Anthrax Vaccine (What is a Reference PDF Opens New Window document?)
• Chickenpox (Varicella) Vaccine (What is a Reference PDF Opens New Window document?)
• Childhood Immunization Catch-Up Schedule: Ages 4 Months to 18 Years (What is a Reference PDF Opens New Window document?)
• Childhood Immunization Record (What is a Reference PDF Opens New Window document?)
• Childhood Immunization Schedule: Ages 0 to 6 Years (What is a Reference PDF Opens New Window document?)
• Childhood Immunization Schedule: Ages 7 to 18 Years (What is a Reference PDF Opens New Window document?)
• Diphtheria/Tetanus/Pertussis (DTaP) Vaccine (What is a Reference PDF Opens New Window document?)
• Haemophilus Influenzae Type B (Hib) Vaccine (What is a Reference PDF Opens New Window document?)
• Hepatitis A Vaccine (What is a Reference PDF Opens New Window document?)
• Hepatitis B Vaccine (What is a Reference PDF Opens New Window document?)
• Human Papillomavirus (HPV) – Cervarix Vaccine (What is a Reference PDF Opens New Window document?)
• Human Papillomavirus (HPV) – Gardasil Vaccine (What is a Reference PDF Opens New Window document?)
• Inactivated Influenza Vaccine (Flu Shot) (What is a Reference PDF Opens New Window document?)
• Japanese Encephalitis – Ixiaro Vaccine (What is a Reference PDF Opens New Window document?)
• Live, Intranasal Influenza Vaccine (Nasal Spray Flu Vaccine) (What is a Reference PDF Opens New Window document?)
• Measles/Mumps/Rubella (MMR) Vaccine (What is a Reference PDF Opens New Window document?)
• Measles/Mumps/Rubella/Varicella (MMRV) Vaccine (What is a Reference PDF Opens New Window document?)
• Meningococcal Vaccine (What is a Reference PDF Opens New Window document?)
• Pneumococcal Conjugate (PCV) Vaccine (What is a Reference PDF Opens New Window document?)
• Pneumococcal Polysaccharide (PPSV) Vaccine (What is a Reference PDF Opens New Window document?)
• Polio (IPV) Vaccine (What is a Reference PDF Opens New Window document?)
• Rabies Vaccine (What is a Reference PDF Opens New Window document?)
• Rotavirus Vaccine (What is a Reference PDF Opens New Window document?)
• Shingles Vaccine (What is a Reference PDF Opens New Window document?)
• Smallpox Vaccine (What is a Reference PDF Opens New Window document?)
• Tetanus/Diphtheria (Td) and Tetanus/Diphtheria/Pertussis (Tdap) Vaccine (What is a Reference PDF Opens New Window document?)
• Typhoid Vaccine (What is a Reference PDF Opens New Window document?)
• Yellow Fever Vaccine (What is a Reference PDF Opens New Window document?)

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