System Frequency Scales (SFS)

System Frequency Scales (SFS)

Laurel D. Fraser MA LMFT
How frequently have you experienced the following symptoms
over the last two weeks ?
Name*

First NameLast Name
Feelings of sadness

Not at allSometimesFrequentlyAll the time
Difficulty falling asleep and/or staying asleep

Not at allSometimesFrequentlyAll the time
Desire to spend a lot of time sleeping

Not at allSometimesFrequentlyAll the time
Fatigue or loss of energy

Not at allSometimesFrequentlyAll the time
No interest in formerly pleasant activities

Not at allSometimesFrequentlyAll the time
Feelings of worthlessness

Not at allSometimesFrequentlyAll the time
Feelings of hopelessness

Not at allSometimesFrequentlyAll the time
Feelings of excessive and/or inappropriate guilt

Not at allSometimesFrequentlyAll the time
Thoughts of being punished

Not at allSometimesFrequentlyAll the time
Impaired ability to concentrate

Not at allSometimesFrequentlyAll the time
Indecisiveness

Not at allSometimesFrequentlyAll the time
Excessive appetite OR poor appetite

Not at allSometimesFrequentlyAll the time
Feelings of restlesness

Not at allSometimesFrequentlyAll the time
Sense of moving slowly

Not at allSometimesFrequentlyAll the time
Thoughts of death

Not at allSometimesFrequentlyAll the time
Thoughts of suicide

Not at allSometimesFrequentlyAll the time
Unplanned weight gain or weight loss

NoYes
If so, please indicate gain or loss and how much .
Anxiety

Not at allSometimesAll the timeOther
Inability to relax

Not at allSometimesFrequentlyAll the time
Nervousness

Not at allSometimesFrequentlyAll the time
Numbness or tingling

Not at allSometimesFrequentlyAll the time
Heart pounding or racing

Not at allSometimesFrequentlyAll the time
Indigestion and/or abdominal discomfort

Not at allSometimesFrequentlyAll the time
Feelings of choking

Not at allSometimesFrequentlyAll the time
Shaky

Not at allSometimesFrequentlyAll the time
Scared

Not at allSometimesFrequentlyAll the time
Difficulty breathing

Not at allSometimesFrequentlyAll the time
Racing thoughts

Not at allSometimesFrequentlyAll the time
Sweating (not due to heat)

Not at allSometimesFrequentlyAll the time
Dizziness or lightheadedness

Not at allSometimesFrequentlyAll the time
Fear of the worst happening

Not at allSometimesFrequentlyAll the time
Fear of losing control

Not at allSometimesFrequentlyAll the time
Fear of dying

Not at allSometimesFrequentlyAll the time
Signature*

Clear
Should be Empty: