A health journal template is a readymade document which is used to keep record of personal or family health. Such templates are easily customisable and can be used to fill in personal information. They prove to be helpful as they help to save precious time. The main use of such templates is generally for health centres or medical institutes and is distributed by them to the patients or clients. These institutes can personalise these templates by adding their details or points which suit their requirements or purpose. Any health journal template is easily available and is easy to use. If you are looking for a sample f any kind of health templates, then you have landed on just the right website.

“You can Download the Free Health Journal Template form, customize it according to your needs and Print. Health Journal Template is either in MS Word, Excel or in PDF.”

Sample Health journal template

Health journal template

Download Health journal template

Name: _____________ [mention name of the person for whom the journal is being made]

Doctor’s name: __________________ [name of the doctor of the person for whom the journal is being made]

Clinic name and address: ____________ [doctor’s clinic’s name and address]

Phone number of doctor: ______________ [write doctor’s phone number]

Starting date of health journal: _______ [dd/mm/yy]

Termination date of health journal: ____________ [dd/mm/yy]

List of appointments:

Date                          physician/phone number                               reason for visit

[Make a list of all appointments with all the doctor’s visited during the journal length]

Personal habits:

Do you:

Drink alcohol: ________ [yes/no]

//If yes, drinks per day: ___________ [write number of drinks per day]//

Currently smoke: _______ [yes/no]

//Packs per day: _____________ [write number of packs per day]//

Exercise: _______ [yes/no]

//Time given to exercising: __________ [write the amount of time devoted on exercising]//


Date:                 Allergic to?                 Symptoms and reactions

[Make a list of all the allergies and their symptoms and reactions date wise]

Family history:

Condition:                  Relation with patient            When was the patient diagnosed

Cancer, type





Chronic conditions

Heart disease


High /low blood pressure


Drug name         dosage              directions   Purpose     date started

[Make a list of all medications used and all the other details in the columns given]