Bedtime Routine Log Form
Use this Bedtime Routine Log Form to record your nightly bedtime routine and track your habits over time.
Date of Routine
*
-
Month
-
Day
Year
Date
What time did you start your bedtime routine?
*
Hour Minutes
AM
PM
AM/PM Option
What time did you go to bed?
*
Hour Minutes
AM
PM
AM/PM Option
Did you brush your teeth?
*
Yes
No
Did you read, listen to music, or do another relaxing activity?
Read
Listened to music
Meditated
Other
Did you use any screens (TV, phone, tablet, computer) before bed?
*
Yes
No
Did you have any snacks or drinks before bed?
No
Snack
Drink (non-caffeinated)
Drink (caffeinated)
How would you describe your mood before going to bed?
Please Select
Calm
Neutral
Stressed
Happy
Sad
Other
What time did you turn the lights out?
Hour Minutes
AM
PM
AM/PM Option
Additional notes about your bedtime routine
Submit Log
Should be Empty: