System Frequency Scales (SFS)
Laurel D. Fraser MA LMFT
How frequently have you experienced the following symptoms
over the
last two weeks
?
Name
*
First Name
Last Name
Feelings of sadness
Not at all
Sometimes
Frequently
All the time
Difficulty falling asleep and/or staying asleep
Not at all
Sometimes
Frequently
All the time
Desire to spend a lot of time sleeping
Not at all
Sometimes
Frequently
All the time
Fatigue or loss of energy
Not at all
Sometimes
Frequently
All the time
No interest in formerly pleasant activities
Not at all
Sometimes
Frequently
All the time
Feelings of worthlessness
Not at all
Sometimes
Frequently
All the time
Feelings of hopelessness
Not at all
Sometimes
Frequently
All the time
Feelings of excessive and/or inappropriate guilt
Not at all
Sometimes
Frequently
All the time
Thoughts of being punished
Not at all
Sometimes
Frequently
All the time
Impaired ability to concentrate
Not at all
Sometimes
Frequently
All the time
Indecisiveness
Not at all
Sometimes
Frequently
All the time
Excessive appetite OR poor appetite
Not at all
Sometimes
Frequently
All the time
Feelings of restlesness
Not at all
Sometimes
Frequently
All the time
Sense of moving slowly
Not at all
Sometimes
Frequently
All the time
Thoughts of death
Not at all
Sometimes
Frequently
All the time
Thoughts of suicide
Not at all
Sometimes
Frequently
All the time
Unplanned weight gain or weight loss
No
Yes
If so, please indicate gain or loss and how much .
Anxiety
Not at all
Sometimes
All the time
Other
Inability to relax
Not at all
Sometimes
Frequently
All the time
Nervousness
Not at all
Sometimes
Frequently
All the time
Numbness or tingling
Not at all
Sometimes
Frequently
All the time
Heart pounding or racing
Not at all
Sometimes
Frequently
All the time
Indigestion and/or abdominal discomfort
Not at all
Sometimes
Frequently
All the time
Feelings of choking
Not at all
Sometimes
Frequently
All the time
Shaky
Not at all
Sometimes
Frequently
All the time
Scared
Not at all
Sometimes
Frequently
All the time
Difficulty breathing
Not at all
Sometimes
Frequently
All the time
Racing thoughts
Not at all
Sometimes
Frequently
All the time
Sweating (not due to heat)
Not at all
Sometimes
Frequently
All the time
Dizziness or lightheadedness
Not at all
Sometimes
Frequently
All the time
Fear of the worst happening
Not at all
Sometimes
Frequently
All the time
Fear of losing control
Not at all
Sometimes
Frequently
All the time
Fear of dying
Not at all
Sometimes
Frequently
All the time
Signature
*
Print
Save
Submit
Should be Empty: