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Distress Thermometer
NCCN Distress Management Screening
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Q1. Please circle the number (0-10) that best describes how much distress you have been experiencing in the past week, including today.
Extreme Distress
10
9
8
7
6
5
4
3
2
1
0
No Distress
Problem List: Have you had concerns about any of the items below in the past week, including today?
Q2. Physical Concerns
Q3. Emotional Concerns
Q4. Practical Concerns
Q5. Social Concerns
Q6. Spiritual / Religious
Q7. Other Concerns:
0/200 characters used
Distress Score
0 (No Distress) to 10 (Extreme)
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