Fatigue Severity Scale Fatigue Severity Scale Name(Required) First Last Date(Required) DD slash MM slash YYYY Please choose the number between 1 and 7 which you feel best fits the following statements. This refers to your usual way of life within the last week. 1 indicates "strongly disagree" and 7 indicates "strongly agree."1. My motivation is lower when I am fatigued(Required)Please enter a number from 1 to 7.2. Exercise brings on my fatigue(Required)Please enter a number from 1 to 7.3. I am easily fatigued(Required)Please enter a number from 1 to 7.4. Fatigue interferes with my physical functioning(Required)Please enter a number from 1 to 7.5. Fatigue causes frequent problems for me(Required)Please enter a number from 1 to 7.6. My fatigue prevents sustained physical functioning(Required)Please enter a number from 1 to 7.7. Fatigue interferes with carrying out certain duties and responsibilities(Required)Please enter a number from 1 to 7.8. Fatigue is amongst my most disabling symptoms(Required)Please enter a number from 1 to 7.9. Fatigue interferes with my work, family or social life(Required)Please enter a number from 1 to 7.Please choose which number describes your global fatigue with 0 being worst and 10 being normal.(Required) 0 1 2 3 4 5 6 7 8 9 10
