Gambling Session Log Form
Use this form to record and reflect on your gambling sessions for better self-awareness and tracking.
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Session Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Session End Time
*
Hour Minutes
AM
PM
AM/PM Option
Location of Gambling Session
*
Please Select
Casino
Online
Home Game
Other
Type(s) of Gambling Activities
*
Slots
Table Games (e.g., Poker, Blackjack)
Sports Betting
Lottery/Scratch Cards
Online Games
Other
Approximate Total Amount Spent (USD)
*
Approximate Total Amount Won (USD)
*
Approximate Total Amount Lost (USD)
*
What was your primary reason for gambling during this session?
*
Entertainment
Socializing
To win money
Stress relief
Habit
Other
How would you rate your emotional state during this session?
*
1
2
3
4
5
Did you set a budget or time limit before this session?
*
Yes, both budget and time limit
Only budget
Only time limit
No limits set
Did you stick to your planned limits?
*
Yes
No, exceeded budget
No, exceeded time limit
No, exceeded both
What triggers, if any, influenced your decision to gamble this session?
Boredom
Stress/Anxiety
Social Pressure
Advertising/Promotions
None
Other
Overall, how satisfied are you with your gambling session?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
Additional Comments or Reflections (optional)
Submit Log
Should be Empty: