HOW TO COMPLETE THIS SCORECARD

NOW: Rate each symptom using the 0-10 scale. 0 = completely absent; 10 = as severe as it has ever been.
Reviews: Re-score at each practitioner check-in so protocol effectiveness can be tracked over time.
Context: Add brief clarification in the right-hand column wherever relevant.
Save: Complete the scorecard in this browser page, then use Download Completed PDF before closing or refreshing.
Markers: ★ = Highest-priority executive performance markers. ♂ / ♀ = Sex-specific items.

Full Name

Date of Birth

Gender

Occupation

Date (Now)

Review 1 Date

Review 2 Date

Review 3 Date

Composite Domain Score Summary

Domain subtotals are simple sums of entered 0-10 symptom ratings. The composite score is the simple sum of the seven domain subtotals.

0Not present

1-2Mild / occasional

3-5Moderate / regular

6-8Significant / frequent

9-10Severe / constant