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 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 *

Clear
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