MedStart Psychiatry · Patient Tools
Mood & Sleep Weekly Tracker
Name: _______________________
Week of: _______________________
Clinician: Jolanta Iłowska, PMHNP-BC
How to use this tracker: Fill in each row every evening before bed. Use the 1–10 scales below. Bring this sheet to your next appointment — it helps your clinician see patterns that a single visit cannot capture.
Rating Scales
1Very Low / Worst
2–3Low / Poor
4–5Below Average
6–7Moderate / OK
8–9Good
10Excellent / Best
Daily Log
Day / Date Mood
(1–10)
Anxiety
(1–10)
Energy
(1–10)
Sleep Hrs Sleep Quality
(1–10)
Medication
Taken? Y/N
Notable Events / Triggers
Monday ___/___
Tuesday ___/___
Wednesday ___/___
Thursday ___/___
Friday ___/___
Saturday ___/___
Sunday ___/___
Weekly Average
Weekly Reflection — What patterns do you notice? What helped? What made things harder?
Questions I want to bring to my next appointment