REVISED FIBROMYALGIA IMPACT QUESTIONNAIRE FIQR - drpodell 2026

1. Click ‘Get Form’ to open the REVISED FIBROMYALGIA IMPACT QUESTIONNAIRE in the editor.
2. Begin by entering your Last Name, First Name, Date, and Date of Birth at the top of the form.
3. In Section I: Activity Level, for each activity listed, select a number from 0 (No difficulty) to 10 (Very difficult) that reflects your experience over the past week. Ensure you check the box corresponding to your chosen rating.
4. After completing Section I, add your scores and write down your Sub-total score. Divide this number by 3 to find your Adjusted sub-total score.
5. Proceed to Section II: Overall Impact. Rate how fibromyalgia affected your goals and feelings of being overwhelmed using the same scale from 0 to 10. Record both Sub-total and Adjusted sub-total scores.
6. In Section III: Intensity of Symptoms, rate each symptom's intensity over the past week on a scale from 0 to 10. Sum these scores and divide by 2 for your Adjusted sub-total score.
7. Finally, enter all Adjusted sub-total scores into Section IV and calculate your Total Adjusted Final Score by adding them together.

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