lead-magnets
Personal Cycle Health Record
A full personal cycle health record: a quick record card, cycle date history, a daily symptom tracker, medicines and allergies, tests and care contacts, and one-page visit summaries.
A cycle health record is a place for the facts you may need later, at a visit, a test, a refill, or when a new symptom shows up.
It can be paper, a file, or an app you trust. It does not tell you what is wrong or what care to choose. It helps you bring clear notes to care.
Quick record card
Keep this page near the front.
Field Your notes Name used at care visits Date of birth Main clinic or care team Pharmacy Emergency contact, if you want one Last period start date Usual cycle length and period length Current birth control or hormone medicine Health notes you want clinicians to know Notes you do not want in shared files
Cycle date history
Use one row per cycle. A rough date is better than a blank.
Cycle Period start Period end Cycle length Flow days Spotting days Main symptoms Notes : : : 1 2 3 4 5 6
Daily symptom tracker
Use one row per day. Skip any field that does not matter to you.
Date Cycle day Flow Pain 0 to 10 Symptoms Medicine or supplement Sleep Notes : : none, spotting, light, medium, heavy, very heavy cramps, headache, nausea, mood, bowel, bladder, other good, okay, poor
Keep notes short. "Day 2 cramps, missed class" may help more than a long paragraph.
Flow words:
Word Plain meaning None No bleeding Spotting A few marks or light stains Light You use light protection or change less often Medium You change protection every few hours Heavy You change often or plan around bleeding Very heavy You leak, soak through fast, or feel worried
If bleeding feels heavy, sudden, or unsafe, contact a clinician. Do not wait to finish this sheet.
Symptom snapshot
Use this for symptoms that come back cycle after cycle, and keep the words plain.
Symptom When it tends to happen How bad, 0 to 10 What helps, if anything What makes it worse Ask about this? : Cramps Pelvic pain Heavy bleeding Headache or migraine Mood or sleep change Digestive change Other
Do not use this table to name a cause. Use it to show a pattern.
Medicines and supplements to mention
Write what you take now, including birth control, hormones, pain medicine, vitamins, herbs, and over the counter medicine. Include pads, tampons, cups, discs, or period underwear if they matter to a symptom.
Name Dose, if known How often Why you take it Started Stopped Helped? Notes yes / no / not sure
Do not start, stop, or change medicine because of this worksheet. Ask a clinician or pharmacist.
Allergies and reactions
Bring this to visits and pharmacy calls.
Medicine, food, product, or material What happened When it happened How severe Who knows about it?
If you are not sure whether something was an allergy, write "reaction" and describe it.
Tests, images, and procedures
Keep dates and locations. You do not need to copy full reports here.
Date Test or procedure Where it was done Why it was done Result summary Where the record lives
Examples may include blood work, urine tests, Pap tests, STI tests, ultrasound, MRI, surgery, or biopsy.
Care contacts
Role Name Clinic or company Phone or portal What they handle Primary care OB GYN or clinician Pharmacy Lab Insurance plan
Questions for your next visit
Write questions before the visit, with the most important one first.
Priority Question Why you are asking Answer or next step : 1 2 3
One page visit summary
Fill this out before a visit and keep it short.
Field Your notes Main reason for the visit When it started, and what changed Worst day or pattern Top symptoms Current medicines and supplements Allergies or reactions Recent tests or visits What you want help deciding What you want kept private
Short notes help when the visit feels rushed. Missed work, missed school, leaks, pain, sleep loss, and fear are all worth naming.
End of cycle review
Answer these after the period ends.
Question Your answer How many days did bleeding last? Which day had the heaviest flow? Which symptom bothered you most? What helped you get through the day? What do you want to ask next time? What should stay private?
What to keep out of shared notes
Some notes belong in your private record first. Before you copy them into a portal, app, email, family calendar, or shared note, ask:
Does my clinician need this exact detail? Could a shorter note work? Does this name another person? Does this include sex, pregnancy, location, travel, money, or legal concerns? Could this show on a shared screen, or save to cloud photos, downloads, email, or texts?
Private copy checklist:
A paper copy at home. A copy you can bring to a visit. A copy that does not sync to a shared account. A list of records you still need. A plan for old screenshots or downloads. A note about what not to share.
Privacy and Floriva note
MedlinePlus notes that personal health records help people keep information from many sources in one place, and that preparing questions ahead of a visit makes conversations clearer. HHS explains individual rights under HIPAA for records held by covered providers and health plans but a personal record like this one, kept on paper or in a consumer app, is not automatically covered by those same rules.
Floriva can hold cycle notes on your device, and should be checked against the same privacy questions as any app: where is data stored, can you export it, and can you delete it. For a full app privacy checklist, use the period app privacy audit kit. This record should serve you keep the parts that help, and skip the parts that do not.