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Daily Anxiety Symptoms Tracking Sheet

Monitor and Manage Your Anxiety Symptoms

Psychiatry

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Last updated: Mar 24, 2025

Patient Information

Name: ___________________ Date Range: //___ to //___

Daily Symptom Rating Scale

0 = None | 1 = Mild | 2 = Moderate | 3 = Severe | 4 = Extreme

Physical Symptoms

Rate each symptom daily:

Symptom Mon Tue Wed Thu Fri Sat Sun
Rapid heartbeat ___ ___ ___ ___ ___ ___ ___
Sweating ___ ___ ___ ___ ___ ___ ___
Trembling ___ ___ ___ ___ ___ ___ ___
Shortness of breath ___ ___ ___ ___ ___ ___ ___
Chest tightness ___ ___ ___ ___ ___ ___ ___

Psychological Symptoms

Symptom Mon Tue Wed Thu Fri Sat Sun
Worry ___ ___ ___ ___ ___ ___ ___
Racing thoughts ___ ___ ___ ___ ___ ___ ___
Difficulty concentrating ___ ___ ___ ___ ___ ___ ___
Irritability ___ ___ ___ ___ ___ ___ ___

Trigger Log

Note situations that caused anxiety:

Date: //___ Trigger: _________________ Severity (0-4): ___ Coping strategy used: ___________________ Effectiveness (0-4): ___

Weekly Summary

Overall anxiety level (0-4): ___ Most effective coping strategies: ____________________ Notes for discussion with healthcare provider: ____________________

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