Questionnaire

The tests listed below are commonly part of the initial patient information packet and need to be filled out just before your first visit except for the General Questionnaire (GQ) which needs to be returned with your $1200 booking fee and other documents needed to book a visit, contained in the information packet.

General Questionnaire (GQ)

The GQ allows our appointment secretary to screen your answers looking for major symptom patterns that suggest CFS and to determine if this will be a good match and offer an appointment. She will likely call you back to discuss further your answers and answer any questions you may have before an appointment is offered. This is the first step to gain an appointment at the Cheney Clinic. Download and fill this GQ out and mail or fax to The Cheney Clinic.
Download the General Questionnaire (pdf) and fax to The Cheney Clinic.

Multiple Symptom Questionnaire or MSQ

The MSQ gives us very important prognostic information which is related to your total score. It also provides a measure of how many symptoms you have and their frequency and severity. The pattern of symptoms is also of interest.
Download the Multiple Symptom Questionnaire (pdf).

Karnofsky Performance Scale Score (KPS)

This scores your level of disability and will be confirmed by physician interview

MSQ – SF36

The SF36 is a validated clinical testing instrument long used to evaluate the level of functional illness in CFS. It is divided into physical and mental components