A chronic fatigue syndrome screening form helps clinicians collect consistent pre-visit information from patients reporting ongoing fatigue, reduced stamina, and related symptoms. This template is structured for healthcare intake, making it easier to review fatigue duration, onset, possible triggers, and core symptom patterns before an appointment.
The form includes contact and referral details along with screening questions about how long persistent fatigue has been present, whether it began suddenly or gradually, and whether an illness, surgery, trauma, or other event may have come before symptom onset. It also covers whether rest improves symptoms, which is an important part of understanding how fatigue affects daily function.
To support more detailed review, the template includes scaled symptom items focused on fatigue severity, motivation, and exercise-related worsening. These questions can help surface patterns such as post-exertional symptom aggravation and non-restorative recovery, giving providers a clearer picture during the intake stage while still leaving room for follow-up assessment and clinical judgment.
