Body Temperature Recording Sheet

Name of person filling out form (optional)____________________________.

Email address (optional)______________________________.

Gender_____Age (Yrs.)______(Mos.) ______Date of Birth___/___/______

Temperature taken by:  Mother_____   Father_____   Other________________.

Instructions:

Please use an oral mercury-in-glass thermometer (not a digital thermometer).  Preferably, use a basal metabolic thermometer, which is a longer thermometer often used in determining prime times for conception and that has finer gradations on the temperature scale.  This will enable you to provide a more precise temperature reading.  Using a basal metabolic thermometer is not an absolute requirement for participation in this study, but it would be much appreciated.

Measurements are to be taken before meals or at least 1 hr. after meals and at least 1 hr. after vigorous activity.  Please take measurements of at least 3 min. duration using a clock with a second hand to determine the time the thermometer should be removed from the mouth.  Given the nature of the difficulty with delay, it may be difficult to take 3 min. measurements.  If this is problematic, please list actual time elapsed before removing the thermometer from the mouth.

We need 4 measurements in total, taken over two days.  On the first day, please take the temperature sometime between 3pm and 5:30pm.  On the second day take a basal reading (first morning temp. before arising from bed), a reading between 9am and 12:30pm, and a reading between 3pm and 5:30pm.

 

Type of Thermometer:        Basal_____    Regular_____

Day 1

Date:  mo.____day____Yr.____     Ambient Temperature ________(inside)

3:00 PM – 5:30 PM:  TIME________   ______ ⁰F       3min.____ Other (min/sec)_______

Day 2

Date:  mo.____day____Yr.____     Ambient Temperature ________(inside)

Basal AM Temp: TIME________   ______ ⁰F             3min.____ Other (min/sec)_______

9:00 AM – 12:30 PM:  TIME________   ______ ⁰F     3min.____ Other (min/sec)_______   

3:00 PM – 5:30 PM:  TIME________   ______ ⁰F       3min.____ Other (min/sec)_______