TirednessQuestionnaire

If you intend to come to see the doctor or nurse about Tiredness, it might help if you could print out and complete this questionnaire, and bring it along with you when you come to see your doctor.

If you are feeling Anxious or Depressed as well, it would help if you could also complete another questionnaire to bring- click here

Name ............................................. Date of Birth .............

Telephone No....................................Today's Date ..............

Describe how you feel as accurately as you can .

2. When did it start?....................................................

3. Is there any variation with time of day or day of the week?

4. (Women only) Does it vary with your menstrual cycle?.

5. Please list any other symptoms ................................

6. Are you more depressed, worried or irritable than normal?

7. Do you have difficulty getting off to sleep?......................

8. Do you ever waken from your sleep for no reason? ..........

9. Are you gaining or losing weight?..................................

10. What are your smoking and drinking habits?

11. Is your job too easy or too difficult?

12. Could you please express any views, opinions, theories or secret fears which
may have been suggested or have crossed your mind as the cause of
your symptoms?

13. Is there anything else I should know?.

Physical Examination.

Investigations.

Diagnosis.

Diagnosis Review.