Compass 31 PostP3A Training HE This survey is the Compass 31. It is a well established self-report instrument used by health care providers to learn about the health of the nervous system. Please read each question carefully and respond thoughtfully. Please enter your ID and Zip/Postal Code at the end of the survey, along with today's date. OK Question Title * 1. In the past year, have your ever felt faint, dizzy, "goofy", or had difficulty thinking soon after standing up from a sitting or lying position? Yes No- If you marked NO, please skip to question #5 OK Question Title * 2. When standing up, how frequently do you get these feelings or symptoms? Rarely Occasionally Frequently Almost always OK Question Title * 3. How would you rate the severity of these feelings or symptoms? Mild Moderate Severe OK Question Title * 4. In the past year, have these feelings or symptoms that you experienced : Gotten much worse Gotten somewhat worse Stayed about the same Gotten somewhat better Gotten much better Completely gone OK Question Title * 5. In the past year, have you ever noticed color changes in your skin, such as red, white, or purple? Yes No (If you responded NO to this question, please skip to question #8) OK Question Title * 6. What parts of your body are affected by these color changes? Check all that apply. HANDS FEET OK Question Title * 7. Have the changes in skin color: Gotten much worse Gotten somewhat worse Stayed about the same Gotten somewhat better Gotten much better Completely gone OK Question Title * 8. In the past 5 years, what changes, if any, have occurred in your general body sweating? I sweat much more than I used to. I sweat somewhat more than I used to. I haven't noticed any changes in my sweating. I sweat somewhat less than I used to. I sweat much less than I used to. OK Question Title * 9. Do your eyes feel excessively dry? Yes No OK Question Title * 10. Does your mouth feel excessively dry? Yes No OK Question Title * 11. For the symptoms of dry eyes and dry mouth that you have had for the longest time, it this symptom: I have not had any of these symptoms. Getting much worse Getting somewhat worse Staying about the same Getting somewhat better Getting much better Completely gone OK Question Title * 12. In the past year, have you noticed any changes in how quickly you get full when eating a meal? I get full a lot more quickly now than I used to. I get full more quickly now than I used to. I haven't noticed any change. I get full less quickly now than I used to. I get full a lot less quickly than I used to. OK Question Title * 13. In the past year, have you felt excessively full or persistently full (bloated feeling) after a meal? Never Sometimes A lot of the time. OK Question Title * 14. In the past year, have you vomited after a meal? Never Sometimes A lot of the time. OK Question Title * 15. In the past year, have you had a cramping or colicky abdominal pain? Never Sometimes A lot of the time. OK Question Title * 16. In the past year have you had any bouts of diarrhea? Yes No (If you marked NO, please skip to question 20.) OK Question Title * 17. How frequently does this occur? Rarely Occasionally Frequently Constantly OK Question Title * 18. How severe are the bouts of diarrhea? Mild Moderate Severe OK Question Title * 19. Have the bouts of diarrhea: Gotten much worse Gotten somewhat worse Stayed about the same Gotten somewhat better Gotten much better Completely gone OK Question Title * 20. In the past year have you had been constipated? Yes No (If you marked NO, please skip to question 24.) OK Question Title * 21. How frequently are you constipated? Rarely Occasionally Frequently Constantly OK Question Title * 22. How severe are these episodes of constipation? Mild Moderate Severe OK Question Title * 23. Has your constipation: Gotten much worse Gotten somewhat worse Stayed about the same Gotten somewhat better Gotten much better Completely gone OK Question Title * 24. In the past year, have you ever lost control of your bladder function? Never Occasionally Frequently Constantly OK Question Title * 25. In the past year, have you had difficulty passing urine? Never Occasionally Frequently Constantly OK Question Title * 26. In the past year, have you had trouble completely emptying your bladder? Never Occasionally Frequently Constantly OK Question Title * 27. In the past year, without sunglasses, has bright light bothered your eyes? Never (If you marked Never, please skip to question 29.) Occasionally Frequently Constantly OK Question Title * 28. How severe is this sensitivity to bright light? Mild Moderate Severe OK Question Title * 29. In the past year, have you had trouble focusing your eyes? Never (If you marked Never, please skip to question 31.) Occasionally Frequently Constantly OK Question Title * 30. How severe is the focusing problem? Mild Moderate Severe OK Question Title * 31. Has the most troublesome symptom with your eyes (i.e. sensitivity to bright lights or trouble focusing) I have not had any of these symptoms. Gotten much worse. Gotten somewhat worse. Stayed about the same. Gotten somewhat better. Gotten much better. Completely gone. OK Question Title * 32. Please enter today's date. Date / Time Date OK Question Title * 33. Please enter your ID Code OK Question Title * 34. Please enter your zip/postal code. OK SUBMIT