Nijmegen Questionnaire

Nijmegen Questionnaire

Never - never. Rare - Once a month. Sometimes - Once a week. Often - every second day. Very often - daily

Chest Pain (sore chest wall)

Never

Rare

Sometimes

Often

Very Often

Feeling Tense (physical tension)

Never

Rare

Sometimes

Often

Very Often

Blurred Vision (fuzzy eyes)

Never

Rare

Sometimes

Often

Very Often

Dizzy Spells (light-headedness)

Never

Rare

Sometimes

Often

Very Often

Feeling confused (poor concentration/spaced out)

Never

Rare

Sometimes

Often

Very Often

Faster deeper breathing

Never

Rare

Sometimes

Often

Very Often

Short of breath (breathlessness)

Never

Rare

Sometimes

Often

Very Often

Tight feelings in chest

Never

Rare

Sometimes

Often

Very Often

Bloated feeling in the stomach

Never

Rare

Sometimes

Often

Very Often

Tingling fingers

Never

Rare

Sometimes

Often

Very Often

Unable to breathe deeply (sighing a lot)

Never

Rare

Sometimes

Often

Very Often

Stiff fingers or arms

Never

Rare

Sometimes

Often

Very Often

Tight feelings around the mouth

Never

Rare

Sometimes

Often

Very Often

Cold hands or feet

Never

Rare

Sometimes

Often

Very Often

Heart racing (palpitations)

Never

Rare

Sometimes

Often

Very Often

Feelings of anxiety (busy brain)

Never

Rare

Sometimes

Often

Very Often

Nijmegen Questionnaire