Symptom Questionnaire

Dear Client,

Please use this scale to rate the frequency and severity of symptoms you have experienced over the past two weeks.
Please kindly complete this questionnaire two days prior to your next session.

  • Leave the score blank if you Never have the symptom.
  • Use a 1 if you Occasionally have it and the effect is Mild.
  • Use a 2 if you Occasionally have it and the effect is Severe.
  • Use a 3 if you Frequently or Consistently have it and the effect is Mild.
  • Use a 4 if you Frequently or Consistently have it and the effect is Severe.
  • If multiple choices are given, please specify what applies in the comment column.

Copyright © 2024 DNA Care - All rights reserved - Disclaimer