Modified Fatigue Impact Scale (MFIS) Modified Fatigue Impact Scale (MFIS) Patient first name(Required)Last name(Required)Email(Required) Enter Email Confirm Email Date of Birth(Required)Date(Required) MM slash DD slash YYYY Please read each statement carefully and choose/select the option that corresponds with how often you have been impacted with the symptom in the past 4 weeks.Q1 – I have been less alert. Never Rarely Sometimes Often Almost always Q2 – I have had difficulty paying attention for long periods of time. Never Rarely Sometimes Often Almost always Q3 – I have been unable to think clearly. Never Rarely Sometimes Often Almost always Q4 – I have been clumsy and uncoordinated. Never Rarely Sometimes Often Almost always Q5 – I have been forgetful. Never Rarely Sometimes Often Almost always Q6 – I have had to pace myself in my physical activities. Never Rarely Sometimes Often Almost always Q7 – I have been less motivated to do anything that requires physical effort. Never Rarely Sometimes Often Almost always Q8 – I have been less motivated to participate in social activities. Never Rarely Sometimes Often Almost always Q9 – I have been limited in my ability to do things away from home. Never Rarely Sometimes Often Almost always Q10 – I have had trouble maintaining physical effort for long periods. Never Rarely Sometimes Often Almost always Q11 – I have had difficulty making decisions. Never Rarely Sometimes Often Almost always Q12 – I have been less motivated to do anything that requires thinking. Never Rarely Sometimes Often Almost always Q13 – My muscles have felt weak. Never Rarely Sometimes Often Almost always Q14 – I have been physically uncomfortable. Never Rarely Sometimes Often Almost always Q15 – I have had trouble finishing tasks that require thinking. Never Rarely Sometimes Often Almost always Q16 – I have had difficulty organizing my thoughts when doing things at home or at work. Never Rarely Sometimes Often Almost always Q17 – I have been less able to complete tasks that require physical effort. Never Rarely Sometimes Often Almost always Q18 – My thinking has been slowed down. Never Rarely Sometimes Often Almost always Q19 – I have had trouble concentrating. Never Rarely Sometimes Often Almost always Q20 – I have limited my physical activities. Never Rarely Sometimes Often Almost always Q21 – I have needed to rest more often or for longer periods. Never Rarely Sometimes Often Almost always Rev 8.8.2022NameThis field is for validation purposes and should be left unchanged.