Date
Your Initials
1. Trouble sleepingSlept better
2. Less energyMore energy
3. Anxious/NervousCalm/Relaxed
4. More HyperLess Hyper
5. Sad or downHappier/Feeling Up
6. Got a headacheReduction of headache
7. Poor concentrationBetter concentration
8. Too jazzed upMoving in slow motion
9. More tic behaviorReduction in tics
10. Spaciness/cognitively 'foggy'More awake/alert
11. Emotional discomfortFeeling of well-being
12. Felt physically worseFelt physically better
List any other noted changes