Monthly Health Dashboard

Complete this one-page summary at the end of each month to track your overall progress. Use it as a check-in with yourself, your coach, or your healthcare provider.

Name:

Month:

Treatment Month #:

Current Medication

Medication: ___________________

Current Dose: ___________________

Injection Day: ___________________

Any dose changes this month? ___________________

Weight & Measurements

Weight (start of month)

Weight (end of month)Change: ____

Total weight lost to date

Waist (inches)Change: ____

Hips (inches)Change: ____

BMI

Energy & Mood (This Month Average)

Energy Level:

12345

1=very low, 5=excellent

Mood:

12345

Sleep Quality:

12345

Side Effects:

12345

1=none, 5=severe

Avg Appetite:

12345

1=no appetite, 5=very hungry

Non-Scale Victories This Month

Check all that apply:

Clothing fits better or went down a size
More energy throughout the day
Better sleep quality
Improved bloodwork results
Increased physical activity
Better relationship with food
More confidence
Reduced medication for other conditions
Other: _________________________
Other: _________________________

Monthly Health Dashboard

Current Medication

Weight & Measurements

Energy & Mood (This Month Average)

Non-Scale Victories This Month

Notable Achievements

Goals for Next Month

Questions for My Provider