Physical Symptoms
Cognitive Symptoms
Emotional Symptoms
Results
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot
Not at all
A little
Moderately
A lot