The daily check-in

One page. For you, and for your next appointment.

What it's for

A 30-second daily note. Two reasons to bother: it helps you spot patterns, and it gives your doctor or prescriber real data instead of "I think it's been okay?" when they ask how things have been.

This is a tracking tool, not a medical record and not advice. Share it with a professional; don't use it to make medication decisions on your own.

The daily row

Print one page per week. Each morning or night, fill one row. Numbers are just your own gut read, 1 (rough) to 5 (great).

Day	Sleep (hrs)	Focus 1–5	Mood 1–5	Meds taken?	One thing that helped
Mon
Tue
Wed
Thu
Fri
Sat
Sun

The margin list

Keep a running list of things to raise at your next appointment, so you don't forget them in the room.

Question I want to ask my doctor:

Side effect or change I noticed:

Something that's working I want to keep:

Before your appointment

📌

Bring the last few weeks of pages, or snap photos. "Here's roughly how the last month went" is one of the most useful things you can hand a provider, and one of the hardest to reconstruct from memory.

Haze to Health is not a medical or mental-health provider. We do not diagnose, treat, or prescribe. This is educational and organizational information only, not medical, legal, or psychological advice. Only a licensed professional can evaluate or diagnose ADHD or any other condition.

If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, free and confidential.