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Parkinson's Disease Symptom Tracking Chart

Daily Progress Monitoring Tool for Patients and Caregivers

Neurology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date Started: _________________

Daily Symptom Rating Scale

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

Motor Symptoms

Date Tremor Stiffness Balance Walking Freezing
____ _______ _________ _______ ________ ________

Non-Motor Symptoms

Date Sleep Fatigue Mood Memory Pain
____ ______ ________ ____ _______ ____

Medication Tracking

Time Medication Dose Taken (✓) Notes
____ __________ ____ _________ _____

Daily Activities

  • Exercise completed: □ Yes □ No
  • Hours of sleep: ____
  • Stress level (1-5): ____

Notes

Side effects/concerns: ________________________________ Questions for doctor: ________________________________

Instructions

  1. Complete chart daily
  2. Rate symptoms at same time each day
  3. Bring to all medical appointments
  4. Note medication changes
  5. Record any falls or significant events

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