Free printable GLP-1 template
Printable GLP-1 Dose & Symptom Tracker
Use this free weekly worksheet to record prescribed GLP-1 doses, injection dates, symptoms, appetite changes, and questions for your clinician.
How to use this tracker
Keep the dose, timing, injection site, symptoms, and follow-up questions in one place. Fill it in after each planned dose and bring the record to your next appointment.
Medication overview
Copy these details from the current label or written instructions.
Dose record
Record each planned dose and what happened.
| Date & time | Dose from label | Taken / skipped / unsure | Injection site | Notes or question |
|---|---|---|---|---|
Seven-day symptom notes
Describe what you noticed, when it happened, and how it affected your day.
| Day / date | What you noticed | When and how long | Impact on your day | Question or follow-up |
|---|---|---|---|---|
| Day 1 | ||||
| Day 2 | ||||
| Day 3 | ||||
| Day 4 | ||||
| Day 5 | ||||
| Day 6 | ||||
| Day 7 |
Questions for your clinician
Common questions about the worksheet
Can this tracker remind me when it is time for my dose?
The printable worksheet is a paper log. In Seven for iPhone, add the schedule you already follow and turn on local reminders to help you remember planned doses. Seven reminds you; it does not set or change your dose.
What belongs in the symptom column?
Write any change you want to discuss, including when it began, how long it lasted, its effect on your day, and what happened next.