Scholar Owl’s Mood Tracker Template

This is what we came up with at my therapist’s office earlier this week for Scholar Owl’s Health/PE elective this year for improving his skills in managing his Bipolar symptoms. It is set up to use the clinical numeric scale and aimed to be user friendly for those who aren’t used to mood trackers.

Date:        
Rate from a scale of 0 to 10 the following (0 = none and 10 = extreme)
AM
Time of Sleep:   Wake Time:  
Quality of Sleep:   Mood/Emotion:  
Anxiety:   Impulsivity:  
Irritability:   Energy Level:  
PM
Time of Sleep:   Wake Time:  
Quality of Sleep:   Mood/Emotion:  
Anxiety:   Impulsivity:  
Irritability:   Energy Level:  
Activities of Daily Living (ADLs)
AM Oral Hygiene (Y/N?):   Shower/Bath (Y/N?):  
PM Oral Hygiene (Y/N?):   Daily Chores (Y/N?):  
Clean Clothes (Y/N?):   Schoolwork (Y/N?):  
Medications/Supplements (What you took and When):
           
           
           
           
           
           
           
           
           
Physical Activities (What you did and for how long for exercise):
           
           
           
           
           
           
           
           
           
Additional Notes for the Day (menses, highlights of the day, unusual events, etc.)
           
           
           
           
           
           
         

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