Dr. Greg NighNaturopathic Physician

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Patient screening tool

Fatigue Symptom Questionnaire

Greg Nigh, ND

Please read: This is an educational screening tool only. It is NOT a medical diagnosis. Results are for discussion with your healthcare provider. Always consult a qualified clinician. By submitting you acknowledge this is not medical advice.

First name *

Last name *

Check every question you would answer yes

Leave a box unchecked if the answer is no or does not apply. There are 78 questions in total.

1.Have you unintentionally lost weight in the past 3–6 months?2.Have you unintentionally gained weight in the past 3–6 months?3.Do you frequently crave salt or salty foods?4.Do you feel dizzy or lightheaded when standing up from sitting or lying down?5.Have you had unexplained nausea or vomiting?6.Have you had recurrent unexplained abdominal pain or discomfort?7.Have you noticed darkening of your skin (especially in creases, scars, knuckles, nipples, gums, or inside the mouth)?8.Do you have white patches of skin (vitiligo)?9.Do you feel unusually sensitive to cold temperatures?10.Are you more constipated than usual?11.Is your skin unusually dry?12.Has your hair become coarser, thinner, or more brittle?13.Do you have puffiness or swelling around your face or eyes?14.Has your voice become hoarser?15.Has your interest in sex (libido) decreased significantly?16.(Men) Do you have difficulty achieving or maintaining an erection?17.(Women of reproductive age) Have your menstrual periods stopped or become much less frequent?18.Do you experience hot flashes or night sweats?19.Have you lost hair from your armpits or pubic area?20.(Men) Have you noticed reduced facial or body hair growth?21.Do you feel markedly weaker in your muscles?22.Have you had episodes of severe weakness or near-collapse during illness or stress?23.Do you often feel nauseated first thing in the morning?24.Have you noticed that previously high blood pressure has become lower or easier to control?25.Has your appetite decreased significantly?26.Has your appetite stayed the same or increased while gaining weight?27.Do you feel colder than other people in the same room?28.Are your periods heavier than usual (if still menstruating)?29.Do you have vaginal dryness that is new or worsening?30.Have you noticed any change in the color of old scars (darker)?31.Do you feel your energy is lowest in the morning?32.Do you have joint or muscle aches without a clear cause?33.Have you lost the ability to tolerate physical stress or exercise as well as before?34.Do you feel mentally slowed or have trouble concentrating in a “foggy” way?35.Have you developed a preference for warmer environments or extra clothing?36.Do salty snacks or soups make you feel noticeably better?37.Have you had unexplained low blood sugar symptoms (shakiness, sweating when hungry)?38.Have you taken glucocorticoid medications (prednisone, dexamethasone, high-dose inhaled steroids, steroid injections, etc.) for weeks or longer and recently tapered or stopped them?39.Have you had persistent headaches, especially with visual changes or loss of peripheral vision?40.Have you been diagnosed with a pituitary tumor, had pituitary surgery or radiation, or experienced sudden severe headache with vision loss?41.Do you have symptoms of other hormone deficiencies (e.g., new low libido, erectile dysfunction, or amenorrhea not explained by other causes)?42.Have you used opioids long-term?43.Do you snore loudly or has anyone told you that you stop breathing or gasp during sleep?44.Do you wake up feeling unrefreshed even after a full night’s sleep?45.Do you frequently fall asleep during the day (e.g., while reading, watching TV, or driving)?46.Do you need more naps than most people?47.Do you have trouble falling asleep or staying asleep most nights?48.In the last four weeks, have you felt down, depressed, or hopeless?49.Have you lost interest or pleasure in activities you usually enjoy?50.Do you often feel nervous, anxious, or on edge?51.Do you worry excessively about many different things?52.Do you feel short of breath with mild activity that used to be easy?53.Have you noticed unusual bruising or bleeding (gums, nose, easy bruises)?54.Do you feel pale or has anyone commented that you look pale?55.(Women) Do you have very heavy menstrual bleeding that soaks through pads/tampons quickly?56.Do you get short of breath when lying flat or need extra pillows to sleep?57.Do you wake up at night suddenly short of breath?58.Do you have swelling in your legs or ankles?59.Do you have chest pain or pressure with activity?60.After even mild physical or mental activity, do you feel much worse for hours or days (a “crash”)?61.Does rest fail to significantly relieve your fatigue?62.Has the fatigue significantly limited your ability to work, care for yourself, or do household tasks?63.Have you had unexplained fevers?64.Have you had drenching night sweats?65.Have you noticed any new lumps or swollen lymph nodes (neck, armpit, groin)?66.Have you had unexplained bleeding (other than periods)?67.Do you urinate much more frequently than usual, especially at night?68.Are you unusually thirsty most of the time?69.Have you recently started any new prescription, over-the-counter, or herbal medications?70.Do you drink alcohol most days or more than recommended amounts?71.Have you used recreational drugs or had problems with substance use?72.Is your diet significantly restricted or missing major food groups?73.Do you work night shifts or have a highly irregular sleep schedule?74.Have you been under major ongoing stress (work, family, financial)?75.Do you feel your physical fitness has declined markedly (deconditioning)?76.Have you had a recent viral illness (including COVID) from which you never fully recovered energy?77.Do you have chronic joint pain, stiffness, or diagnosed autoimmune/rheumatologic disease?78.Are you pregnant or could you be pregnant?

Privacy: your responses are stored securely and are visible only to the clinic for review. They are not shared with anyone else.

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