Chronic Fatigue Syndrome Diagnostic Screening Form

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complex condition that requires careful evaluation. This Chronic Fatigue Syndrome Diagnostic Screening Form helps healthcare providers gather essential pre-visit information to assess potential CFS/ME cases efficiently.

Built with Paperform, this template streamlines the screening process by collecting detailed patient history, fatigue severity measurements, post-exertional malaise indicators, and sleep quality assessments—all before the appointment. The form uses conditional logic to adapt questions based on symptom patterns, ensuring you capture the most relevant clinical information without overwhelming patients.

Key features of this CFS screening template:

• Validated fatigue severity scales to measure the impact of fatigue on daily functioning
• Post-exertional malaise assessment to identify hallmark CFS/ME symptom patterns
• Comprehensive sleep quality evaluation including sleep disruption and non-restorative sleep indicators
• Symptom duration and onset tracking to establish chronicity criteria
• Associated symptom checklist covering cognitive impairment, orthostatic intolerance, and pain symptoms
• Medical history section to rule out alternative diagnoses

Healthcare practices can use this form to improve diagnostic accuracy while reducing appointment time spent on initial symptom gathering. The structured format ensures consistent data collection across patients, making it easier to identify patterns and track symptom progression over time.

For practices looking to further streamline their workflow, connect this form to your EHR system using Stepper to automatically route completed screenings to the appropriate provider, flag high-priority cases, and trigger follow-up appointment scheduling. You can also use Paperform's built-in scheduling features to let patients book their consultation directly after completing the screening.

Whether you're a primary care physician, specialist in chronic illness, or integrated health clinic, this template provides a professional, patient-friendly way to conduct thorough CFS/ME screenings that support evidence-based diagnosis and treatment planning.