IV Therapy Medical Symptoms Questionnaire (MSQ) Logo
  • Medical Symptoms Questionnaire

  • Rate each of the following symptoms based on the last 48 hours: 

    Point Scale   0 Never or almost never have the symptom   3 Frequently have it, effect is not severe
      1 Occasionally have it, effect is not severe   4 Frequently have it, effect is severe
      2 Occasionally have it, effect is severe  
  • HEAD

  • EYES

  • EARS

  • NOSE

  • MOUTH/THROAT

  • SKIN

  • HEART

  • LUNGS

  • DIGESTIVE TRACT

  • JOINTS/MUSCLE

  • WEIGHT

  • ENERGY/ACTIVITY

  • MIND

  • EMOTIONS

  • OTHER

  • Should be Empty: