Your Wellness Journey Begins Here
Personal Information
Uncover your goals and personalize your path
Name
*
First Name
Last Name
Age
*
Under 18
18-24
25-34
35-44
45-54
55-64
Above 64
Gender
*
Male
Female
Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Subjective Energy Level Assessment Questionnaire
Instructions for the Patient: Please reflect on your recent experiences regarding your energy levels and respond to the following questions. Choose the option that best represents your feelings or experiences over the past month. Your honest and thoughtful responses will aid in understanding your current state and determining if further evaluation is warranted.
Scoring Key:
0: No concern 1: Mild concern 2: Moderate concern 3: High concern
1. Morning Energy:Upon waking, how do you typically feel?
Energetic and ready to start the day (0)
Fairly alert but slow to start (1)
Struggling to feel awake and motivated (2)
Extremely fatigued and unprepared for the day (3)
Score 1
2. Midday Energy:How would you describe your energy levels halfway through your day?
Still high and productive (0)
Slightly lowered but manageable (1)
Significantly dropped, affecting tasks (2)
Nearly depleted, needing a break to continue (3)
Score 2
3. Evening Energy:As the day ends, how do you feel?
Have enough energy for evening activities (0)
A bit tired but can manage activities (1)
Too tired for many activities, prefer relaxation (2)
Completely drained, desire for immediate rest (3)
Score 3
4. Energy Restoration:How do you feel after taking short breaks or resting periods during the day?
Fully rejuvenated (0)
Somewhat refreshed (1)
Minimally better (2)
No significant change in energy levels (3)
Score 4
5. Mental Energy:How would you describe your level of mental alertness and focus throughout the day?
Consistently sharp and focused (0)
Generally good with occasional lapses (1)
Often struggle to stay focused and alert (2)
Feel mentally exhausted and unfocused most of the time (3)
Score 5
6. Emotional Energy:How do you typically feel about engaging with others or emotional tasks?
Energetic and engaged (0)
Somewhat engaged but reserve energy (1)
Reluctant due to feeling drained (2)
Overwhelmed and avoidant due to lack of energy (3)
Score 6
7. Physical Stamina:How would you rate your physical stamina for daily tasks and activities?
Can easily handle physical tasks (0)
Handle tasks with some effort (1)
Struggle with physical tasks (2)
Avoid physical tasks due to lack of energy (3)
Score 7
8. Social Energy:What is your usual energy level for social interactions?
High, enjoy engaging with others (0)
Moderate, engage but limit socializing (1)
Low, socializing feels draining (2)
Very low, often avoid social interactions (3)
Score 8
9. Motivation Levels:How motivated do you feel to pursue interests or hobbies?
Highly motivated (0)
Somewhat motivated (1)
Barely motivated (2)
Lack motivation for interests/hobbies (3)
Score 9
10. Daily Fluctuations:How consistent are your energy levels throughout a typical day?
Very consistent (0)
Some fluctuations, but predictable (1)
Unpredictable and significant fluctuations (2)
Always low with little variation (3)
Score 10
11. Response to Stress:How does a stressful situation affect your energy levels?
Maintain energy, manage stress well (0)
Slight drop in energy, but recoverable (1)
Noticeable energy depletion (2)
Completely overwhelmed and drained (3)
Score 11
12. Feelings of Restfulness:Do you feel rested and restored after a full night's sleep?
Yes, always (0)
Most of the time (1)
Rarely (2)
Almost never (3)
Score 12
13. Ability to Relax:How easy is it for you to relax and unwind?
Very easy, can relax at will (0)
Somewhat easy with some effort (1)
Difficult, relaxation feels unachievable (2)
Extremely difficult, never feel truly relaxed (3)
Score 13
14. Energy Compared to Others:How do you perceive your energy levels in comparison to peers?
Higher or the same (0)
Slightly lower (1)
Often lower (2)
Always lower (3)
Score 14
15. Impact on Daily Life:How much do your energy levels impact your ability to perform daily activities?
No impact, function normally (0)
Minor impact, some adjustments needed (1)
Moderate impact, many activities affected (2)
Major impact, daily life significantly altered (3)
Score 15
Final Score
Scoring:
Total your scores. A higher total score indicates a greater subjective feeling of low energy, which may warrant further professional evaluation: 0-15: Low Concern. Your subjective energy levels appear healthy. 16-30: Moderate Concern. Some aspects of your energy perception might benefit from professional guidance. 31-45: High Concern. A professional evaluation is recommended to explore underlying causes and appropriate interventions. Note: This questionnaire is intended to assess subjective feelings of energy and is not a diagnostic tool. If you have concerns about your energy levels or overall health, please consult a healthcare professional.
Based on your responses, we may recommend Hyperbaric Oxygen Therapy (HBOT) as a potential treatment option. For a deeper understanding of HBOT, a brief video is available below. If you'd like to discuss your specific needs with a consultant, simply click the "Make Appointment" button and we will be in touch shortly.
Disclaimer of Liability
This questionnaire is intended for initial assessment purposes only and is not to be used as a diagnostic tool. It does not replace professional medical evaluation, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider regarding any medical condition or before starting any new treatment. If in doubt about your health, seek medical assistance immediately. Usage of this questionnaire does not create a doctor-patient relationship with Boost Asia Ltd. or its affiliates.
Make Appointment
Should be Empty: