Mental Health Cycle Tracking Log Form
Use this form to log and review your mental health cycle patterns over time. All questions are general and non-diagnostic.
Date of Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you describe your overall mood today?
*
Please Select
Very Positive
Positive
Neutral
Negative
Very Negative
Other
Energy Level
*
High
Moderate
Low
Other
Quality of Sleep Last Night
Very Restful
Restful
Average
Restless
Very Restless
Stress Level
Low
1
2
3
4
High
5
1 is Low, 5 is High
Activities Engaged In Today
Work/Study
Exercise
Socializing
Relaxation
Creative Activities
Other
Social Interactions Today
None
Minimal
Moderate
Frequent
Other
Did you notice any physical symptoms today? (Optional, general observations only)
Fatigue
Headache
Tension
None
Other
Coping Strategies Used Today
Mindfulness
Exercise
Talking to Someone
Journaling
Other
Additional Notes or Reflections (Optional)
Submit
Should be Empty: