Peptimes

Side effect log: blank, ready to print

Print with Command-P on a Mac or Ctrl-P on Windows. It fits one sheet of US Letter or A4 in portrait. If the print preview isn't in portrait, choose it in the print dialog, and turn off headers and footers for a cleaner page.

On a small screen, scroll sideways to see the whole sheet.

All printable logs and how to use them

Side effect log

How to use: Write what you noticed in your own words, as soon as you can. Circle one intensity, using the scale you define below. Keep guesses about causes in Notes. If nothing happened, "nothing noticed" is a useful entry. Bring this sheet to appointments.

Name
Dates to
Page of
Your intensity scale:
1 means
5 means
DateTimeWhat you noticedin your own wordsIntensitycircle oneNotes
12345
12345
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12345
12345
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12345
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12345
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If something worries you, contact your prescriber. If it feels severe or sudden, call 911 or your local emergency number.