Name:

Today I am years old plus days (day month year to appear here, in parenthesis)

Today, I awoke from hours of sleep.

Today, I drank this many cups of coffee or tea:

Today, I smoked this many cigarettes:

Today I

Today I had the following number of bowel movements:
n/a 1 2 3 4 5

Today I have sex.

Today I masturbate.

Today I have at least one orgasm.

I am on the following day of my menstrual cycle today (for menstruating women only):
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
31 32 33 34 35

Today, I had an interesting conversation with about

The most exciting thing I did today was

The most boring thing I did today was

On a scale of 1-10, my level of happiness today was
1 2 3 4 5 6 7 8 9 10

On a scale of 1-10, my level of anxiety today was
1 2 3 4 5 6 7 8 9 10

I fill out this form today, instead of making art

Updated January 2009 | Acknowledgements | Copyright 1998-2009 Risa Horowitz