Print this sheet to use as an old-school method of recording your activities and symptoms to share with your healthcare provider.
| Day | Hours Sleep | Hours Rest | Activities and Events | Pain | Fatigue | Brain Fog | Other Symptoms | Comments | Rating |
|---|---|---|---|---|---|---|---|---|---|
| Monday | |||||||||
| Tuesday | |||||||||
| Wednesday | |||||||||
| Thursday | |||||||||
| Friday | |||||||||
| Saturday | |||||||||
| Sunday | |||||||||
Summit Natural Health Centre | 5133 Dundas Street West, Etobicoke ON M9A 1C1 | 416-236-7642 | contactus@summitnaturalhealth.ca
The Doctor's Note 