1. Have you experienced persistent or relapsing chronic fatigue over the past six or more months?
   Yes    No
2. Is your fatigue severe enough to interfere with your daily activities?
   Yes    No
3. Do you feel unusually tired or drained for 24 hours following exercise or other forms of physical exertion?
   Yes    No
4. Do you feel tired even after a nap or a good night's sleep?
   Yes    No
5. Have you experienced problems concentrating or remembering things since the onset of your fatigue?
   Yes    No
6. Have you experienced a chronic or recurring sore throat since the onset of your fatigue?
   Yes    No
7. Have you experienced chronic or recurring muscular pain since the onset of your fatigue?
   Yes    No
8. Have you experienced chronic or recurring joint pain with no swelling or redness since the onset of your fatigue?
   Yes    No
9. Have you experienced chronic or recurring headaches since the onset of your fatigue?
   Yes    No
10. Was the onset of your fatigue preceded by a physical or emotional trauma, such as a car accident, bereavement or major surgery?
    Yes    No
11. Was the onset of your fatigue preceded by a bout of mononucleosis or a respiratory, gastrointestinal or other acute illness with flu-like symptoms?
    Yes    No
12. Do you have multiple allergies as well as chronic fatigue?
    Yes    No

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