Pre-Office Questions

Please save a lot of time and answer these questions before your visit. We will help as well.

FATIGUE

Q: Is fatigue your worst problem?
Q: How long has it affected your daily life (Weeks, months, years)?
Q: Has it been continuous?
Q: Did it gradually worsen?
Q: Is it associated with any of the events listed below?
Q: Constant or does it worsen during a time of the day such as mornings?
Q: Is it stable or worsening?

CIRCLE PROBLEMS

Associated Symptoms

Sleep disturbances, snoring/apnea, chest pain, palpitations, shortness of breath, fever, weight change, depression, anxiety, concentration problems.

What makes it worse or better

Rest, diet, caffeine, naps, stress, exercise.

Past Medical History

Heart disease, thyroid disease, anemia, lung disease, sleep apnea, autoimmune conditions, cancer history, infections (COVID, mononucleosis, etc).

Medications

Are you on beta blockers, sedatives including sleeping meds, antihistamines? Did any start your tiredness?

Family History

Includes depression, others complaining about fatigue. Heart disease, thyroid disorders, autoimmune diseases (like Lupus, Rheumatoid Joint disease), cancers.

Social History (SH)

Occupation, stress level.

Inadequate good sleep?

This is common. (Hours, quality. Do you work night shift). Snoring? Witnessed stopping of breathing called apnea.

Diet, caffeine use, alcohol, smoking, recreational drug use.

Exercise habits

Good, bad, none.

Circle If

Weight loss/gain, fever, night sweats.

Heart: Palpitations, chest pain, orthopnea.

Lungs: Dyspnea, Ray changes.

Endocrine: Heat/cold intolerance, diabetes. Have you been on Prednisone?

GI: Appetite changes, diarrhea/constipation.

BLOOD: Easy bruising, bleeding.