The goal of this diary is to record your fluid intake and output 24 hours at a time. You may start at any time of day. Please write down how much (in ounces) you had to drink – INTAKE – and how much you urinated –OUTPUT- (in ounces) every hour. You may print this page using you browser's print function, or download the page as an Adobe .PDF file.

Your diary is very important to us so please write down everything and bring it with you to your appointment.

Intake    

Output

Intake

Output

Intake

Output

7AM

8AM

9AM

10AM

11AM

NOON

1PM

2PM

3PM

4PM

5PM

6PM

7PM

8PM

9PM

10PM

11PM

MN

1AM

2AM

3AM

4AM

5AM

6AM