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ADRENAL FATIGUE QUESTIONNAIRE

Dr. Wilson’s Adrenal Fatigue Questionnaire

From Adrenal Fatigue: The 21st Century Stress Syndrome
by Dr. James L. Wilson

This questionnaire covers many of the common fatigue causes and stress symptoms associated with fatigued adrenal glands. Although not meant to be a stand-alone diagnostic tool, this stress quiz can be helpful in indicating the presence and degree of adrenal fatigue.

Instructions: Using the values in the rating scale below, enter the appropriate response number in the columns below. Once you have answered all of the questions, scroll to the bottom of the page and click the “Calculate” button. Your score and assessment will be displayed.

Note: The “Past” column refers to the last time you felt well (before your symptoms seemed to noticeably worsen). All your responses in the “Past” column will be about how you felt before that date – it’s helpful to write this date or approximate time down so you don’t forget it. The “Now” column is not necessarily about today, but about how you generally feel now, in this present time frame or since the date you entered for the “Past” column.