MDforever

Patient Information

Name: ___________________ Date Started: //___

Daily Mood Scale

Rate your mood each day (0 = worst, 10 = best)

Week of: //___

Day	Mon	Tue	Wed	Thu	Fri	Sat	Sun
Mood Rating

Symptom Checklist

Check any symptoms experienced today:

□ Low mood/sadness □ Loss of interest in activities □ Sleep changes □ Appetite changes □ Difficulty concentrating □ Fatigue □ Feelings of worthlessness □ Thoughts of self-harm

Medication Tracker

Medication Name: _________________ Dosage: _________ Taken as prescribed? □ Yes □ No Side effects: _______________________________

Activities & Coping Strategies Used

□ Exercise (minutes): _____ □ Social interaction □ Therapy appointment □ Mindfulness/meditation □ Other: ________________

Notes for Discussion with Healthcare Provider

Emergency Contacts

Therapist: _________________ Phone: ________________ Crisis Hotline: 988 Emergency Contact: _________ Phone: ________________

Bring this tracker to all appointments with your mental health provider

Depression Treatment Progress Tracker

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