Chronic Fatigue Symptom Score Questionnaire First Name * Required Last Name * Required Email Address * Required Phone Number * RequiredDo you have trouble sleeping and chronic insomnia (or other sleep disorders)? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have the ability to sleep, but are not feeling rested or refreshed after waking up? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have trouble concentrating or remembering things during the day at work or school? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have chronic muscle pain and soreness, even without exercising? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have joint pain in any part of the body, but without the usual redness or swelling caused by arthritis or other problems? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have unusual or frequent headaches? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have tender or swollen lymph nodes in the neck or armpits? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have a frequent sore throat? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have dizziness when standing up or moving too quickly? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have extreme fatigue after moderate physical or mental activities that may last beyond 24 hours after the activity? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have blurry vision or light sensitivity? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have numbness or a tingling sensation in your hands, feet, or face? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have mood swings or panic attacks and anxiety? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have night sweats? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have a chronic low body temperature or even a low fever temperature? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have irritable bowels without any changes to your usual diet? * Required None (0) Mild (1) Moderate (3) Severe (6) Do you have food sensitivity or allergic reactions you haven’t had before, especially after consuming alcohol, chemical ingredients, or prescription and over-the-counter medications? * Required None (0) Mild (1) Moderate (3) Severe (6) Scoring: < 10: Chronic Fatigue Unlikely 10-24: Mild Chronic Fatigue 25-51: Moderate Chronic Fatigue 52-102: Severe Chronic FatigueIf you would like someone from our team to reach out to you about Chronic Fatigue, please click "submit" below. We will review your answers and reach out to you. Request An Appointment Today Contact Us
