Fatigue Scale Fatigue Scale Patient first name(Required)Last name(Required)Email(Required) Enter Email Confirm Email Date of Birth(Required)Date(Required) MM slash DD slash YYYY Likelihood of falling asleep 0 = would never doze off — 1 = slight chance — 2 = moderate chance — 3 = high chanceSitting and reading 0 1 2 3 Watching TV 0 1 2 3 Sitting quietly in a public place (i.e. theater or meeting) 0 1 2 3 As a passenger in a car for an hour without a break 0 1 2 3 Lying down to rest in the afternoon when able to 0 1 2 3 Sitting and talking to someone 0 1 2 3 Sitting quietly after lunch without alcohol 0 1 2 3 In a car, while stopped for a few minutes 0 1 2 3 Rev 8.8.2022EmailThis field is for validation purposes and should be left unchanged.