Brain Fog Quiz

1

If you are a healthcare or mental health professional, please use our Brain Fog Survey for Professionals here

2

First Name* This field is required.

3

Last Name

4

Email* This field is required.Type your email below.

5

Mobile Number

6

How do you identify yourself?* This field is required.

Male

Female

Other

Don't wish to disclose

8

Have you experienced a serious illness or an event that triggered your current symptoms?* This field is required.

YESNO

9

If Yes, then What?

10

Do you have difficulty concentrating?* This field is required.

YESNO

11

Are you making more mistakes at work or in your daily tasks?* This field is required.

YESNO

12

Are you feeling clumsy, dizzy or off-balance?* This field is required.

YESNO

13

Do you feel guilty because you can't keep up?* This field is required.

YESNO

14

Do you experience insomnia/sleeplessness?* This field is required.

YESNO

15

Do you feel irritable/angry/restless?* This field is required.

YESNO

16

Do you feel confused?* This field is required.

YESNO

17

Do you feel stressed out or anxious?* This field is required.

YESNO

18

Do you have mood swings?* This field is required.

YESNO

19

Are you frequently worried or fearful?* This field is required.

YESNO

20

Do you feel sad or depressed?* This field is required.

YESNO

21

Your Total Score