Medical knowledge, Patient Education
Daily Weight Record
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Make sure you use a reliable scale. Use the same scale each day.
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Keep this daily weight chart near your scale.
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Weigh yourself each morning at the same time after you use the bathroom.
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Before weighing yourself:
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Take off your shoes.
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Make sure you are wearing the same amount of clothing each day.
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Write down your weight in the spaces on the form.
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Compare today’s weight to yesterday’s weight.
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Bring this form with you to your follow-up visits with your health care provider.
Call your health care provider if you have concerns about your weight, including rapid weight gain or loss.
Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
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Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
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Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
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Date: ________ Weight: ____________________ Date: ________ Weight: ____________________
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.
