Chapter Seven

Daily Journal


Date: __________       Pre-Taper / Taper (Circle one) Day # _____, Step # _____

Note: Do Not Change Eating or Exercise Habits During The Program!

Current Drugs & Dosages: (List all taken, time of day and amount)

_______________      _______________      _______________      _______________

_______________      _______________      _______________      _______________

Food and Liquid: (List all food and liquid consumed, time of day and amount)


_______________      _______________      _______________      _______________

_______________      _______________      _______________      _______________


_______________      _______________      _______________      _______________

_______________      _______________      _______________      _______________
 
The Road Back Nutritionals: (List all taken, time of day and amount)


_______________      _______________      _______________      _______________

_______________      _______________      _______________      _______________


_______________      _______________      _______________      _______________

_______________      _______________      _______________      _______________

Rate the Following Areas Using a Scale of 1 to 10: (Rate daytime anxiety at bedtime and rate the previous night's sleep first thing in the morning. Rate all other items before bedtime.)

Symptom

1-10 Rating

List All Changes Made During the Day


Aches

Anxiety    

Appetite

Body Pains

Energy

Exercise

Fatigue


Mood

Sleep

 

 

 

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The Road Back Program