Nijmegen Questionnaire for HVS Test - the question form
Questions: 16 · 3 minutes
1. Chest pain.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
2. Feeling tense.
1 - Never
2 - Rarely
3 - Sometimes
4 - Often
5 - Very often
3. Blurred vision.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
4. Dizziness spells.
Never
Rarely
Sometimes
Often
Very often
5. Disorientation; feeling detached from your surroundings.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
6. Rapid or deepened breathing.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
7. Shortness of breath.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
8. Feeling of tightness in the chest.
1 - Never
2 - Rarely
3 - Sometimes
4 - Often
5 - Very often
9. Feeling of abdominal bloating.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
10. Numbness or tingling in the fingers.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
11. Unable to take a deep breath.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
12. Stiffness in the hands or fingers.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
13. Tension around the mouth.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
14. Cold hands or feet.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
15. Palpitations.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often
16. Feelings of anxiety.
1 – Never
2 – Rarely
3 – Sometimes
4 – Often
5 – Very often