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Chapter Seven

Daily Journal

Date: __________       Pre-Taper / Taper (Circle one) Day # _____, Step # _____

Note: Do Not Change Eating or Exercise Habits During The Program!

Current Drugs & Dosages: (List all taken, time of day and amount)

_______________      _______________      _______________       

Food and Liquid: (List all food and liquid consumed, time of day and amount)

 

 

 

 

 

 

 

 

 

The Road Back Nutritionals: (List all taken, time of day and amount)

 

 

 

 

 

 

 

 

 

 

Rate the Following Areas Using a Scale of 1 to 10: (Rate daytime anxiety at bedtime and rate the previous night's sleep first thing in the morning. Rate all other items before bedtime.)

Symptom

1-10 Rating

Aches

 

Anxiety  

Appetite

 

Body Pains

 

Energy

 

Exercise

 

Fatigue

 

Mood

 

Sleep

 

 

 

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