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EZFC Form #3

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Oxford Instability Score

All fields are required.

Not at all in 6 months
1 or 2 in 6 months
1 or 2 times per months
1 or 2 times per week
More often than 1 or 2 times/ week
No trouble at all
Slight trouble or worry
Moderate trouble or worry
Extreme difficulty
Impossible to do
None
Mild ache
Moderate
Severe
Unbearable
Not at all
A little bit
Moderately
Greatly
Totally
Not at all
Very occasionally
Some day
Most days or maore than oane activity
Evey day or many activities
Not at all
Very occasionally
Some day
Most days or maore than oane activity
Evey day or many activities
Not at all
Very occasionally
Some day
Most days
Evey day
Not at all
A little/ occasionally
Some of the time
Most of the time
All of the time
Never, or only if someone asks
Very occasionally
Some day
Most days
Evey day
Not at all
Very occasionally
Some day
Most days
Evey day
None
Very Mild
Mild
Moderate
Severe
No nights
Only 1 or 2 nights
Some nights
Most nights
Every nights

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