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, 2026Runs in your browser; nothing is sent to a server
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, 2026
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.