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Complete the information for two consecutive 24-hour periods. Record both day and night.

  • Begin with first urination upon arising.

  • Record intake amount in ounces and type of fluid (for example, coffee, juice, water, etc.).

  • Record approximate urine output and time of urination.


Fluid intake

Fluid output

Time of intake (a.m./p.m.)

Amount and type of fluid (oz)

Time of void (a.m./p.m.)

Amount voided (oz)

Leakage (time, place, quantity)

Day 1


Day 2

Last Annual Review Date: 2010-08-01 Copyright: harvard Health Publications

Reference: Overactive Bladder section on Better Medicine

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Did You Know?

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Overactive bladder, or urge incontinence, can happen to men or women at any age, but it's more common in women and older people.