A printable appointment companion
A symptom diary for your next appointment.
A few dated notes can be easier to bring than a week of memories. Use this blank diary on paper, whether or not you use Arveli.
One-page A4 PDF, 65 KB. Free to print. No signup, app download or health-data form. The HTML worksheet below is also available.
Share the blank diary
Copies a link to this blank template, not a completed diary or personal notes.
Keep it useful
What to put in a symptom diary.
A diary organizes observations for a conversation. It cannot tell you why a symptom happened or which treatment you need.
When it happened
Note the date and time, when it began, and how long it lasted. Mark an estimate as an estimate.
What you noticed
Use your own words for the symptom and where you felt it. Add whether it changed, rather than assigning a cause.
The surrounding day
Include context you want to discuss, such as sleep, a period, an activity or a change in routine. Write what you observed, not what you think it proves.
Your questions
Keep a short list of concerns for the visit and a separate current list of medicines, vitamins and supplements. Ask your clinician what is useful to record for your situation.
Kandola LLC · Arveli
Symptom diary
Date range: ______________________ Appointment: ______________________
Write only what you want to record. Keep estimates clear. Leave unknown details blank; a missing entry does not mean there was no symptom. Bring a current list of medicines, vitamins and supplements separately.
On a small screen, scroll the table sideways to see every column. You can also use the one-page PDF above.
| Date & time | Symptom & location | Duration & changes | Context & effect on my day | Medicines taken, if relevant |
|---|---|---|---|---|
| Entry 1 | ||||
| Entry 2 | ||||
| Entry 3 | ||||
| Entry 4 | ||||
| Entry 5 | ||||
| Entry 6 |
Questions I want to ask
Personal notes, not a medical assessment. Do not delay care to complete this diary. Keep completed copies private. Blank template: kandola.org/arveli/symptom-diary
Bring the record, and your questions.
Choose the entries you want to discuss. If dates are uncertain or days are missing, say so. A pattern in a diary is something to ask about; it does not establish a diagnosis or show that a medicine caused a change.
Follow any recording instructions your care team gives you. You do not need a complete diary before asking for help. If a symptom is new, worsening or concerning, contact a qualified healthcare professional; for an emergency, use your local emergency service.
Keep a completed diary private.
This page has no fields for entering symptoms and does not send diary entries to Kandola LLC. Print the blank sheet and fill it in yourself. If you save a PDF, check where your browser saves it and whether that folder syncs to another service.
Before sharing a completed copy, review its dates, notes and recipients. A copy sent to another person or service follows that destination’s privacy practices. Avoid using a public or shared printer for sensitive notes.
Prefer a journal on your phone?
Keep your daily record in Arveli.
Arveli lets you log periods, symptoms, mood, sleep, medicines and private notes on iPhone and iPad. Core tracking works on device without an Arveli account. Basic clinician reports, export and privacy controls are included in Free.
For an appointment, choose the date range and sections for your report, then preview what you share. Arveli organizes records; it does not diagnose, recommend treatment or check medication safety.
The preview is in Arveli’s Life stages feature tab. Read Arveli’s privacy policy before choosing optional connections or sharing.
Sources and scope.
Prepared by Kandola LLC, maker of Arveli. Published November 5, 2026. This original worksheet is for general recordkeeping and appointment preparation, not clinical assessment or personalized medical advice.
The sources below support noting symptoms, timing, medicines and questions before a visit. They have not reviewed or endorsed this worksheet or Arveli.