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Weekly dose log: date, dose as prescribed, site and notes

A twelve-week injection log with a column for the dose exactly as your prescriber wrote it, the injection site, the time and a notes field. Prints on one letter page; add a name and start date to pre-fill the dates.

By FormBlends editorial teamUpdated September 4, 2026Educational, not medical advice

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Weekly dose log

A record of each weekly injection for your own reference and for your prescriber. Copy the dose from your prescription label. This sheet never suggests a dose.

Name:
Medication exactly as written on the label:
Prescriber and phone:
Pharmacy and phone:
Concentration printed on the vial or pen (if any):
Usual injection day:
WeekDateDose as written by prescriberSiteTimeNotes (late, missed, lot number, how you felt)
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Site options: abdomen L / abdomen R / thigh L / thigh R / upper arm L / upper arm R. Labels for Wegovy and Zepbound both say to rotate injection sites with each dose.

Missed a dose?

Follow the missed-dose rule on your own medication's label or your pharmacy's instructions, and write down what you did and when. Rules differ between products, so this sheet does not print one.

Questions to raise at the next visit

A dose log does one thing: it turns "I think I took it Tuesday, maybe the left side" into a row with a date, a dose and a site. Prescribers ask for it because it answers half their questions before they ask them. You keep it because the week you feel worse is usually the week something on the log changed.

How to use it

Enter a start date in the builder above and the date column fills in at seven-day steps, so the sheet already knows which day is yours. Add your name if the sheet will travel with you to a visit. Print it, or copy it as plain text into a notes app if paper is not your thing.

Fill the header once: the medication as it is written on the label, the pharmacy and prescriber phone numbers, and, for a compounded vial, the concentration printed on it. That last line matters more than it looks. Compounded vials change concentration between fills, and the units you draw up depend on it. If the concentration on a new vial differs from the one in the header, stop and ask the pharmacy before you draw anything up. The dose unit converter on the calculators site shows the arithmetic, but the pharmacy's instructions govern.

Each week, write the dose exactly as your prescriber wrote it. Not what you think it should be by now, not what someone in a forum is on. If your prescriber changes the dose, the change appears in the log on the date it happened, which is exactly what a prescriber wants to see.

The site column

The Wegovy and Zepbound labels both name the abdomen, thigh and upper arm as injection sites and say to rotate with each dose. Writing "abdomen L" or "thigh R" each week is the cheapest way to make rotation happen. If you want a grid view, the injection site rotation record does the same job across eight weeks.

Missed doses

The sheet deliberately does not print a missed-dose rule. The Wegovy label's rule is expressed in days until the next scheduled dose, the Zepbound label's in hours since the missed one, and a compounded product follows whatever your pharmacy and prescriber told you. Write down what you did and when; the rule itself lives on your own label.

Pair it with

The side-effect diary is the other half of the record. Together they let a prescriber line up a symptom with the dose and day that preceded it. If cost is part of your conversation, the FormBlends cost report has the current price landscape in one place.

Questions people ask

Why does the log not print my titration schedule?

Because the dates and doses of a titration belong to your prescriber, and the sheet is used by people on different products with different schedules. If you want dated steps laid out, the injection schedule generator on the FormBlends Calculators site does that from the steps on your prescription and exports them as a calendar file. This log records what actually happened.

What goes in the notes column?

Anything you would want to tell your prescriber in six weeks: a late or missed dose and what you did about it, the lot number of a new vial, a leak from the pen, how you felt that evening. Short is fine.

Canonical URL: https://formblendstools.com/templates/weekly-dose-log. Written by the FormBlends editorial team. This page is educational and is not medical advice; see the medical disclaimer.