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Daily Anxiety Monitoring Chart

Track Your Anxiety Symptoms and Progress

Psychiatry

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Template Content

Last updated: Mar 24, 2025

Patient Information

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

Instructions

Rate your anxiety levels and symptoms daily using the scales below. Complete this chart each evening.

Anxiety Level Scale (0-10)

  • 0: No anxiety
  • 5: Moderate anxiety
  • 10: Severe panic

Daily Log

Date Time Anxiety Level (0-10) Trigger/Situation Physical Symptoms Coping Strategy Used Effectiveness (0-10)
//__ : ___ _____________ _____________ _____________ ___

Physical Symptoms Checklist

  • Racing heart
  • Sweating
  • Trembling
  • Shortness of breath
  • Chest tightness
  • Nausea
  • Dizziness
  • Other: _____________

Coping Strategies Used

  • Deep breathing
  • Progressive muscle relaxation
  • Mindfulness exercise
  • Physical exercise
  • Talking to someone
  • Other: _____________

Weekly Summary

Total number of anxiety episodes: ___ Average anxiety level: ___ Most effective coping strategy: _______________

Notes for Discussion with Healthcare Provider

Bring this chart to your next appointment

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