Please enter your Mendus member ID number.
How tall are you?
What is your current weight?
What is your gender?
What is your birth date (DD/MM/YYYY)?
Have you been officially diagnosed with Multiple Sclerosis?
What year were you diagnosed?
In the past two weeks, how much has your MS limited your ability to...
Not at all
A little
Moderately
Quite a bit
Extremely
Do physically demanding tasks?
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Extremely
Grip things tightly (e.g. turning on taps)?
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Extremely
Carry things?
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A little
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Extremely
In the past two weeks, how much have you been bothered by...
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Extremely
Problems with your balance?
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A little
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Extremely
Difficulties moving about indoors?
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Extremely
Being clumsy?
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A little
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Quite a bit
Extremely
Stiffness?
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Extremely
Heavy arms and/or legs?
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Quite a bit
Extremely
Tremor of your arms or legs?
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A little
Moderately
Quite a bit
Extremely
Spasms in your limbs?
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A little
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Quite a bit
Extremely
Your body not doing what you want it to do?
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A little
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Quite a bit
Extremely
Having to depend on others to do things for you?
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Extremely
Limitations in your social and leisure activities at home?
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Extremely
Being stuck at home more than you would like to be?
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Extremely
Difficulties using your hands in everyday tasks?
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Extremely
Having to cut down the amount of time you spent on work or other daily activities?
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A little
Moderately
Quite a bit
Extremely
Problems using transport (e.g. car, bus, train, taxi, etc.)?
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A little
Moderately
Quite a bit
Extremely
Taking longer to do things?
Not at all
A little
Moderately
Quite a bit
Extremely
Difficulty doing things spontaneously (e.g. going out on the spur of the moment)?
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Extremely
Needing to go to the toilet urgently?
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A little
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Extremely
Feeling unwell?
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A little
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Extremely
Problems sleeping?
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A little
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Extremely
Feeling mentally fatigued?
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A little
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Quite a bit
Extremely
Worries related to your MS?
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Extremely
Feeling anxious or tense?
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A little
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Extremely
Feeling irritable, impatient, or short tempered?
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Quite a bit
Extremely
Problems concentrating?
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Extremely
Lack of confidence?
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A little
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Extremely
Feeling depressed?
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A little
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Quite a bit
Extremely
Mark any of the following treatment options that you've tried. You can add treatments which are not on the list in the box below.