COMPASS 31 - modified for on-line administration
(to be completed by a subject under supervision of a trained clinician)

Please answer the following items by clicking on a button for each line.

Do you have any of the following symptoms related to standing:	Never		Monthly				Weekly				Daily				Hourly				Always
	0		1		2		3		4		5		6		7		8		9		10
1.2. In the past year, how often have you felt faint, dizzy, or had difficulty thinking soon after standing up from a sitting or lying position?

For your symptoms after standing:	Neligible				Mild				Moderate						Severe				Extreme
	0		1		2		3		4		5		6		7		8		9		10
3. How would you rate the severity of these feelings or symptoms?

For your symptoms after standing:	All gone				Better				Unchanged						Worse				Much worse
	0		1		2		3		4		5		6		7		8		9		10
4. In the past year, are these feelings or symptoms that you have experienced:

For symptoms related to your skin:	Never		Monthly				Weekly				Daily				Hourly				Always
	0		1		2		3		4		5		6		7		8		9		10
5. In the past year, have you ever noticed color changes in your skin, such as red, white, or purple?

For symptoms regarding your skin:	Neligible		Mild		Moderate			Severe		Extreme
	0	1	2	3	4	5	6	7	8	9	10
6a. Are your hands affected by these color changes?
6b. Are your feet affected by these color changes?

	All gone				Better				Unchanged						Worse				Much worse
	0		1		2		3		4		5		6		7		8		9		10
7. Are these changes in your skin color?

For symptoms related to sweating:	Much more				A little more				Unchanged						A little less				Much less
	0		1		2		3		4		5		6		7		8		9		10
8. In the past 5 years, what changes, if any, have occurred in your general body sweating? Is your sweating:

For symptoms related to your eyes and mouth:	Never	Monthly		Weekly		Daily		Hourly		Always
	0	1	2	3	4	5	6	7	8	9	10
9. In the past year, how often do your eyes feel excessively dry?
10. In the past year, how often does your mouth feel excessively dry?

	All gone				Better				Unchanged						Worse				Much worse
	0		1		2		3		4		5		6		7		8		9		10
11. For any symptom of dry eyes or dry mouth that you have had for the longest period of time, is this symptom:

For symptoms related to your stomach:	I get full a lot more quickly				I get full more quickly				I have not noticed any change						I get full less quickly				I get full a lot less quickly
	0		1		2		3		4		5		6		7		8		9		10
12. In the past year, have you noticed any changes in how quickly you get full when eating a meal compared to before:

	Never	Monthly		Weekly		Daily		Hourly		Always
	0	1	2	3	4	5	6	7	8	9	10
13. In the past year, have you felt excessively full or persistently full (bloated feeling) after a meal?
14. In the past year, have you vomited after a meal?

For symptoms related to your bowel functions:	Never		Monthly				Weekly				Daily				Hourly				Always
	0		1		2		3		4		5		6		7		8		9		10
15. In the past year, have you had a cramping or colicky abdominal pain?

16., 17. In the past year, have you had any bouts of diarrhea?

	Not at all				Mild				Moderate						Severe				Extreme
	0		1		2		3		4		5		6		7		8		9		10
18. How severe are these bouts of diarrhea?

	Never had or all gone				Better				Unchanged						Worse				Much worse
	0		1		2		3		4		5		6		7		8		9		10
19. Are your bouts of diarrhea getting:

20., 21. In the past year,have you been constipated?

	Not at all				Mild				Moderate						Severe				Extreme
	0		1		2		3		4		5		6		7		8		9		10
22. How severe are these episodes of constipation?

	Never had or all gone				Better				Unchanged						Worse				Much worse
	0		1		2		3		4		5		6		7		8		9		10
23. Is your constipation getting:

For symptoms related to your bladder function:	Never		Monthly				Weekly				Daily				Hourly				Always
	0		1		2		3		4		5		6		7		8		9		10
24. In the past year, have you ever lost control of your bladder function?

25. In the past year, have you had difficulty passing urine?

26. In the past year, have you had trouble completely emptying your bladder?

For symptoms related to your vision:	Never		Monthly				Weekly				Daily				Hourly				Always
	0		1		2		3		4		5		6		7		8		9		10
27. In the past year, without sunglasses or tinted glasses, has bright light bothered your eyes?

	Not at all				Mild				Moderate						Severe				Extreme
	0		1		2		3		4		5		6		7		8		9		10
28. How severe is this sensitivity to bright light?

	Never		Monthly				Weekly				Daily				Hourly				Always
	0		1		2		3		4		5		6		7		8		9		10
29. In the past year, have you had trouble focusing your eyes?

	Not at all				Mild				Moderate						Severe				Extreme
	0		1		2		3		4		5		6		7		8		9		10
30. How severe is this focusing problem?

	Never had or all gone				Better				Unchanged						Worse				Much worse
	0		1		2		3		4		5		6		7		8		9		10
31. Is the most troublesome symptom with your eyes (i.e. sensitivity to bright light or trouble focusing) getting:

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Last update: 07/12/2015