Branson Clinic — Symptom & Lifestyle Journal
Phone/Text: 417-239-0125
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Daily Lifestyle
Date
Consent to share CSVs with clinic
No
Yes
Your Clinic Code
Diet (type naturally)
Notes (symptoms, travel, cycle, etc.)
Medications (free text)
Supplements (free text)
Medication timing
—
AM
PM
Bedtime
Onset
Supplement timing
—
AM
PM
Bedtime
Activity Minutes
Steps
Intensity
—
Light
Moderate
Vigorous
Hydration (L)
Sleep Hours
Sleep Quality (1–5)
Bedtime
Waketime
Stress (1–10)
Mood (1–5)
Caffeine after 2pm (count)
Late meal/snack ≤2h before bed
—
No
Yes
Screen time in last 2h (hours)
Resting HR (optional)
HRV (ms, optional)
Menstrual Phase
N/A
Follicular
Ovulation
Luteal
Premenstrual
Menstruation
Symptoms (add any)
Symptom
Severity (0–10)
Duration (hours)
Tags (comma separated)
Symptom notes
Add symptom to today
Save Day
New
Quick Micro-Scales
PSS-4 (weekly)
Unable to control important things?
0
1
2
3
4
Confident to handle problems? (reverse)
0
1
2
3
4
Things going your way? (reverse)
0
1
2
3
4
Could not overcome difficulties?
0
1
2
3
4
Save PSS-4
PHQ-2 (weekly)
Little interest/pleasure in doing things
0
1
2
3
Down, depressed, or hopeless
0
1
2
3
Save PHQ-2
PEG-3 Pain (weekly)
Average pain (0–10)
Pain interference – enjoyment
Pain interference – activity
Save PEG-3
Your Days
