Orthostatic intolerance (past year)

1. In the past year, have you ever felt faint, dizzy, “goofy”, or had difficulty thinking soon after standing up from a sitting or lying position?

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Orthostatic intolerance (frequency)

2. When standing up, how frequently do you get these feelings or symptoms?

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Orthostatic intolerance (severity)

3. How would you rate the severity of these feelings or symptoms?

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Orthostatic intolerance (development)

4. In the past year, have these feelings or symptoms that you have experienced:

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Vasomotor (past year)

5. In the past year, have you ever noticed color changes in your skin, such as red, white, or purple?

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Vasomotor: hands/feet

6. What parts of your body are affected by these color changes?

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Vasomotor: hands

6. What parts of your body are affected by these color changes? Hands

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Vasomotor: feet

6. What parts of your body are affected by these color changes? Feet

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Vasomotor (development)

7. Are these changes in your skin color:

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Secretomotor (5 past years)

8. In the past 5 years, what changes, if any, have occurred in your general body sweating?

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Secretomotor: eyes

9. Do your eyes feel excessively dry?

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Secretomotor: mouth

10. Does you mouth feel excessively dry?

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Secretomotor (development)

11. For the symptom of dry eyes or dry mouth that you have had for the longest period of time, is this symptom:

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Gastroparesis (past year)

12. In the past year, have you noticed any changes in how quickly you get full when eating a meal?

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Gastroparesis: bloat

13. In the past year, have you felt excessively full or persistently full (bloated feeling) after a meal?

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Gastroparesis: vomit

14. In the past year, have you vomited after a meal?

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Gastroparesis: pain

15. In the past year, have you had a cramping or colicky abdominal pain?

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Diarrhea (past year)

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

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Diarrhea (frequency)

17. How frequently does this occur?

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Diarrhea (severity)

18. How severe are these bouts of diarrhea?

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Diarrhea (development)

19. Are your bouts of diarrhea getting:

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Constipation (past year)

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

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Constipation (frequency)

21. How frequently are you constipated?

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Constipation (severity)

22. How severe are these episodes of constipation?

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Constipation (development)

23. Is your constipation getting:

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Bladder (past year)

24. In the past year, have you ever lost control of your bladder function?

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Bladder: urinating

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

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Bladder: emptying

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

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Pupillomotor (past year)

27. In the past year, without sunglasses or tinted glasses, has bright light bothered your eyes?

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Pupillomotor: bright light

28. How severe is this sensitivity to bright light?

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Pupillomotor: focusing

29. In the past year, have you had trouble focusing your eyes?

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Pupillomotor (severity)

30. How severe is this focusing problem?

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Pupillomotor (development)

31. Is the most troublesome symptom with your eyes (i.e. sensitivity to bright light or trouble focusing) getting:

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Orthostatic intolerance domain

Orthostatic intolerance domain

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Vasomotor domain

Vasomotor domain

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Secretomotor domain

Secretomotor domain

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Gastrointestinal domain

Gastrointestinal domain

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Gastroparesis subdomain

Gastroparesis subdomain

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Diarrhea subdomain

Diarrhea subdomain

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Constipation subdomain

Constipation subdomain

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Bladder domain

Bladder domain

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Pupillomotor domain

Pupillomotor domain

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Autonomic symptom score

Autonomic symptom score

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COMPASS 31 version

COMPASS 31 version

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