Shortened Premenstrual Assessment Form
For each of the symptoms below, indicate the number that most closely describes the intensity of your premenstrual symptoms during your last cycle. This phase begins about seven days prior to menstrual bleeding (or seven days before your period) and ends at the time bleeding starts or 2-3 days after.
Rate each item on this list on a scale from “absent” or no change from usual to “extreme change”, perhaps noticeable even to casual acquaintances. For example, if you generally have felt overwhelmed by ordinary demands over the entire month and this did not change the week leading up to menstruation, then you would still answer “no change/absent” for the second question.
This form is in the public domain and based on template provided by Applying Functional Medicine in Clinical Practice