Patient Name: __________________________________________
Month(s):______________
Year: __________________
Cycle Day
Date
Day of Week
Time Temp Taken
Waking Temp
Cycle Day
Last 12 Cycles:
Shortest:__________
Longest: __________
This Cycle Length:_________
1
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31
32
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
1
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
2
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
3
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
4
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
5
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
6
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
7
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
8
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
9
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
10
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
11
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
12
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
13
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
14
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
15
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
16
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
17
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
18
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
19
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
20
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
21
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
22
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
13
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
24
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
25
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
26
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
27
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
28
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
29
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
30
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
31
99
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
98
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
97
0.9
0.8
32
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18
19
20
21
22
13
24
25
26
27
28
29
30
31
32
Ovulation Test
Intercourse
Increased Sex Drive
Cervical Mucus:
Thick, Sticky
Scanty/Dry
MS Symptoms:
Irritability
Headaches
Bloating
Breast Tenderness
Craving Food
Depression
Period Color:
Light Red/Pink
Dark Red
Brown
Bright Red
Heavy
Clots
Spotting
Period Cramps:
Severe
Mild
Moderate
(Yin/Blood)
Vaginal Dryness
Night Sweats
Warm Palms/Soles
Dry Mouth/Eyes
Face Breakout
Dry Hair/Hair Loss
(Yang)
Lower Back Pain
Cold Feet
Nighttime Urine
Low Libido
Fatigue
Vaginal Discharge
Cycle Day