Gambling Cessation Log Form
Use this form to log your progress, experiences, and support actions as you work towards gambling cessation.
Date of Log Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gambling-Free Streak (days)
*
Did you experience any urges or triggers today?
*
Yes
No
Situations or feelings that led to urges (if any)
Coping strategies you used
Contacted a support person
Engaged in a hobby or activity
Practiced mindfulness or relaxation
Avoided risky situations
Other
Support actions taken today
Attended a support group
Talked to a counselor or therapist
Used a self-help resource
Reached out to friends or family
Other
How would you rate your urge to gamble today?
None
1
2
3
4
5
6
7
8
9
Very strong
10
1 is None, 10 is Very strong
Brief follow-up note or reflection
Submit Log
Should be Empty: