Carpal Tunnel Symptom Scoring Questionnaire Form
Please complete the Carpal Tunnel Symptom Scoring Questionnaire Form to help assess the severity and impact of your symptoms. This form is designed for clarity and ease of use.
How often do you experience numbness or tingling in your hand or fingers?
*
Never
Rarely
Sometimes
Often
Constantly
Please rate the severity of pain in your hand or wrist.
*
1
2
3
4
5
How much does your hand or wrist discomfort interfere with daily activities?
*
Not at all
A little
Moderately
Severely
Do you experience hand weakness or loss of grip strength?
*
Never
Rarely
Sometimes
Often
Always
How frequently do your symptoms wake you up at night?
*
Never
Less than once a week
1-2 times per week
3-5 times per week
Every night
Which hand is more affected by your symptoms?
*
Left
Right
Both equally
How long do your symptoms typically last when they occur?
*
Less than 1 minute
1-5 minutes
5-30 minutes
More than 30 minutes
Does shaking your hand relieve your symptoms?
*
Yes, always
Yes, sometimes
No
Please rate your overall hand or wrist discomfort over the past week.
*
1
2
3
4
5
If you would like to add any additional comments about your symptoms, please do so here.
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