Calculator

Template builder

Choose any of the fourteen printable templates (dose log, side-effect diary, checklists, letters, trackers), add an optional name and start date so the date column fills itself, then print the sheet black on white at letter size or copy the whole thing as plain text. Dose columns are never filled: they are for the dose your prescriber wrote.

By FormBlends editorial teamAssumptions checked September 4, 2026 Runs in your browser; nothing is sent to a server

What it computes

Pick a template, add a name and start date, print it or copy it as plain text.

Never pre-fills a dose

Template

Name on the sheet (optional)

Start date (optional)

Fills the date column where the template has one.

FormBlends Tools and Templates

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:

Week	Date	Dose as written by prescriber	Site	Time	Notes (late, missed, lot number, how you felt)
1
2
3
4
5
6
7
8
9
10
11
12

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

Formulashown in full, nothing hidden

row date(n) = start date + n * step days        (step = 7 for weekly sheets, 1 for daily sheets)
dates are computed in UTC from the ISO date you enter, so the printed sheet is the same in any time zone
dose columns are never filled: the value is whatever your prescriber wrote

The plain-text copy is generated from the same data as the printed sheet, so the two always agree.

Assumptions, checked September 4, 2026what the arithmetic takes as given

Template wording was checked against the sources listed under each sheet on the date shown; label storage figures, TSA wording and HealthCare.gov deadlines are quoted as published on that date.
Nothing you type leaves your browser. The name and start date exist only on the sheet you print or copy.
The print layout hides the rest of the page and sets letter-size margins; choose A4 in your print dialog if that is your paper.

This calculator is an arithmetic aid for medication a licensed prescriber has already prescribed. It does not recommend a dose. Confirm any result with your prescriber or pharmacist before use.

Sources

Read before you use it

Guides for this calculator

Paper-cut illustration of a syringe with plain tick marks beside a slide rule and a ruler

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

You'll get: A dose log turns a vague memory into a row with a date, a dose and an injection site.

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.

Updated September 4, 2026

Side-effect diary: symptom, severity 0 to 3, timing after the dose, what helped

You'll get: A fourteen-day diary with a 0 to 3 severity scale, hours since your injection, and what helped.

A fourteen-day diary for GLP-1 side effects with a plain 0 to 3 severity key, a column for hours since the injection, and a printed list of the symptoms the labels say not to wait on.

Updated September 4, 2026

Shot-day checklist: before, during and after the injection

You'll get: Most injection errors are not about technique: a wrong vial, a warm pen, a wrong syringe mark, a needle in the bin.

A tick list for injection day, built from the manufacturers' instructions and FDA sharps guidance: label match, dates, clear solution, site, disposal, log.

Updated September 4, 2026

Educational, not medical advice. Read the medical disclaimer.