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Weekly Routine Planner

A - Activity Categories
B - Daily Record of Activity
C - Weekly Record of Activity
D - Daily Routine Planner
E - Weekly Routine Planner
F - Symptom Score Chart
G - Daily Diary Grid
H - Symptom Categories & Warning Signs

E. Weekly Routine Planner

This form helps you plan a balanced and sustainable weekly routine.  Use the information you have gathered on the Daily or Weekly Record of Activity and consider how to improve your current activity and rest regime; then record an improved schedule on the Weekly Routine Planner.  


The Activity Categories form will also help when thinking how to spread High, Medium and Low activity throughout the day.  Perhaps you have a High activity which you could do on two different days in the week, several days apart? (Your routine can be adjusted when you feel ready to increase activity - or decrease in the case of a relapse.) 


There is 1 completed example and 1 blank template of this form.   Blank forms are available in Word or PDF format.  Example forms are available in PDF format only.   Click on the DOWNLOAD buttons below.

WEEKLY ROUTINE PLANNER - EXAMPLE

Weekly Routine Planner EXAMPLE (pdf)

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WEEKLY ROUTINE PLANNER - BLANK

Weekly Routine Planner BLANK (pdf)

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Weekly Routine Planner BLANK (WORD) (docx)

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CLICK BELOW TO DOWNLOAD A PDF OF ALL THE FORMS AND TEXT - 32 pages (3.3 MB)

Total ME Forms Website (pdf)

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