Nutritionist Seema Singh

CHRONIC FATIGUE SYNDROME SELF ASSESSMENT FORM

AGE

Have you ever been found to have high blood glucose?

SMOKING

ACTIVITY LEVEL (aerobic exercise, at least 30 minutes per session)

STRESS LEVEL (personal perception)

Have you experienced fatigue or tiredness for a prolonged period of time?

Are you able to do only less than 50% of the work you usually do, because of tiredness?

Have you experienced any four of the following symptoms over a period of six months or more?

Thank you for taking our survey.

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