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Symptom Score Chart

A - Activity Categories
B - Daily Record of Activity
C - Weekly Record of Activity
D - Daily Routine Planner
E - Weekly Routine Planner
F - Symptom Score Chart
G - Daily Diary Grid
H - Symptom Categories & Warning Signs

F. Symptom Score Chart

Use this form to help work out a score based on how severe, moderate or mild the symptoms are each day. 


If you look at the form you will see I suggest a score of 1-9 (with 9 being the most well). It is not necessary to consider a '9' as how you were before you developed ME/CFS. Use your own judgement of illness and wellness, that is appropriate to you, to decide how to score your symptoms. The Symptom Score Chart helps consider the illness more objectively. (You may wish to record your score on the Daily Diary Grid.) 


There is 1 completed example and 1 blank template of this form.  Blank forms are available in Word or PDF format.  Example forms are available in PDF format only.   Click on the DOWNLOAD buttons below.

symptom score chart - example

Symptom Score Chart EXAMPLE (pdf)

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SYMPTOM SCORE CHART - BLANK

Symptom Score Chart BLANK (pdf)

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Symptom Score Chart BLANK (WORD) (docx)

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CLICK BELOW TO DOWNLOAD A PDF OF ALL THE FORMS AND TEXT - 32 pages (3.3 MB)

Total ME Forms Website (pdf)

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