ME Forms
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D Daily Routine Planner
You can plan to carry out High, Medium and Low activities in the most useful way throughout the day. If you have completed the Activity Categories form and Daily/Weekly Record of Activity they can also help you to consider a more balanced routine. One example shows how you can use sticky notes to plan the days rest and activity periods, but not necessarily the detail of what you will actually be doing. The routine can then be adjusted when you feel ready to increase activity (or decrease in the case of a relapse!). If you use sticky notes you can move them around accordingly. There are 2 examples and 3 blank templates of this form.
C Weekly Record of Activity
Not as detailed as the Daily Record of Activity but the same objective. Keeping a note of what you do and when you do it can help you see your energy spend over a week and assess the strengths and weaknesses of your current lifestyle. You can use this completed form to help you design a more balanced routine on the Daily/Weekly Routine Planner. There is 1 completed example and 1 blank template of this form.
A Activity Categories
The Activity Categories Form helps you to think about the different types of activity you do and whether each task uses a High, Medium or Low amount of energy. Categorising activity in this way will help you to understand how you spend your energy. You can also use this form with the Daily Record of Activity, Weekly Record of Activity, Daily Routine Planner, Weekly Routine Planner and Daily Diary Grid. There are further explanatory notes on the form itself. There are 2 examples and 1 blank template of this form.
There are 8 different forms/charts/diaries. Click on one of the above buttons to take you to the relevant page. They can be used in the order above (A-H), or individually, to help you build up an overall picture of your current activity. You can then plan a newly balanced routine with properly managed activity, pacing and resting. On each page there are examples of completed forms together with blank templates for you to download. Some pages have several completed examples or several variations of the blank templates. Decide which template best suits you, then download it (for free). Some forms have extra notes at the bottom for with further explanation.
How to Use the Forms
H Symptom Categories and Warning Signs
This form will be specific to you. Your symptoms will present themselves in various different ways. Labelling these symptoms or each cluster of symptoms may give you greater understanding and objectivity of this confusing illness. I have specific symptoms that appear if I overstretch my arms or legs - identifying this and labelling it has helped me to prevent it happening (mostly). The section to complete on warning signs can help you to identify when you need to consider adjusting your activities that day/week. There is 1 completed example and 1 blank template of this form.
E Weekly Routine Planner
You can plan when to carry out High, Medium and Low activities in the most beneficial way throughout the week. Perhaps you have a High activity which you could do on two different days in the week, several days apart? If you have completed the Activity Categories form and the Daily/Weekly Record of Activity they can help you plan a more balanced routine. The routine can then be adjusted when you feel ready to increase activity (or decrease in the case of a relapse). There is 1 completed example and 1 template of this form.
B Daily Record of Activity
A form on which you can record in detail what you are currently doing during the day, how long you do it for and whether it is High, Medium or Low energy use. You could use this form for a couple of days if your daily routine does not vary much, or for longer if your days vary over a week or two. Build up a picture of how you spend your energy and consider the strengths and weaknesses of your current lifestyle in relation to your management of the ME/CFS. You can then use this completed form to help you design a more balanced routine on the Daily/Weekly Planner. If your daily routine does not need to be recorded in detail you may wish to use the Weekly Record of Activity Form instead to build up a picture of your current activity. There are 2 completed examples and 2 blank templates of this form.
Free forms, diaries and charts for the management of ME/CFS.
(Myalgic Encephalomyelitis/Chronic Fatigue Syndrome)
F Symptom Rating Chart
Use this form to help you work out a rating or scoring system based on how severe or mild the ME symptoms are each day. If you look at the form you will see I suggest a score of 1-9, 9 being the most well. It is not necessary to consider a 9 as how you were before you developed ME. You can use your own interpretation of illness and wellness that is appropriate to you on good and bad days. Symptom Rating Chart helps you to look at the ME/CFS more objectively. You may wish to record a daily rate/score on the Daily Diary Grid. There is 1 example and 2 templates of this form.
G Daily Diary Grid
This grid is completed once a day to record important daily statistics - hours slept overnight, hours slept and rested during the day, time spent doing High, Medium and Low activity etc. I provide some blank column headings on one template so you can decide what you would like to record eg use a column to record a specific activity that you are currently gradually increasing, for example using a computer. If you increase the activity weekly or monthly this is the place to record it. You can look back over the previous weeks/months to see what you were doing, and how many minutes or hours a day you were doing it for. It is a snapshot of each day to build up a picture of what works and what doesn't. On this form there are also columns for the Symptom Rating Score and to make a few notes. There are 2 examples and 2 blank templates of this form.