Free printable PDF
CPPS Daily Symptom Log, free printable
This CPPS daily symptom log helps men track pelvic pain, urinary symptoms, sitting tolerance, sleep, stress, and activity context in a consistent daily record. It can be used before or after a formal diagnosis.
Updated May 2026. By Intero.
What is on the form.
01Pelvic and perineal pain scales
02Urinary symptom row
03Ejaculatory pain field
04Sitting tolerance notes
05Sleep, stress, and activity context
Make the pattern easier to see.
- 01Fill in one row per day.
- 02Separate pain locations when they feel different.
- 03Track sitting tolerance if sitting is part of your symptom pattern.
- 04Bring several weeks if you want to discuss changes over time.
Common questions.
- Is this only for men diagnosed with CPPS?
- No. The categories are common symptom areas that may be useful before or after a diagnosis.
- Why include sitting tolerance?
- For some people with pelvic pain, sitting is a useful context marker. Skip it if it does not apply.
- Is the form really free?
- Yes. The PDF is free to download.
Download the PDF, or keep tracking in Intero.
The worksheet is free. The Intero app gives you a private place to keep tracking on iPhone and review patterns over time.
Sources used
These sources informed the structure and language of this tracking worksheet. The form is informational and does not replace medical advice.