Name: ____________ Year of Study: _________

Age: ______________ GPA: _________________

Contact: __________ Email: ________________

Gender: ___________ Field of Study : ________

INSTRUCTION: Please, Tick or Circle the relevant box for any option chosen
BRAINFOG SCALE (BFS SCALE)
Rarel
No Question Never Occasionally Always
y
1 My thinking has been slow 0 1 2 3
2 My thinking has been slow 0 1 2 3
3 I have felt fatigued 0 1 2 3
4 I have been easily distracted 0 1 2 3
5 I have found myself getting annoyed 0 1 2 3
6 I have felt sleepy 0 1 2 3
I have found it difficult to remember
7 0 1 2 3
& understand new information
I have found myself forgetting certain words,
8 0 1 2 3
like names of objects
9 I have found it difficult to think logically 0 1 2 3
10 I have found it difficult to concentrate 0 1 2 3
11 I couldn’t think clearly 0 1 2 3
12 I have had a hard time finding the right words 0 1 2 3
13 I have found it difficult to organise my thoughts 0 1 2 3
14 I have felt like my mind’s gone blank 0 1 2 3
I have found it difficult to understand
15 0 1 2 3
words when reading
I have had a hard time understanding
16 0 1 2 3
what others say
17 I have been daydreaming 0 1 2 3
18 I have felt spacey 0 1 2 3
19 I have felt confused 0 1 2 3
20 I have experienced thought blocking 0 1 2 3
21 I have felt lost 0 1 2 3
I have felt absent, as if I were living in
22 0 1 2 3
my own world
23 My thoughts have been moving quickly 0 1 2 3
 GHQ-12

No Have you recently : Never Rarely Occasionly Always

24 Been able to concentrate on 0 1 2 3
whatever you are doing
25 Lost much sleep over worry 0 1 2 3
26 Felt that you are playing a useful part 0 1 2 3
in things
27 Felt capable of making decisions 0 1 2 3
about things
28 Felt constantly under strain 0 1 2 3
29 Felt you couldn’t overcome your 0 1 2 3
difficulties
30 been able to enjoy your normal day 0 1 2 3
to day activities
31 Been able to face up to your 0 1 2 3
problems
32 Been feeling unhappy and depressed 0 1 2 3
33 Been losing confidence in yourself 0 1 2 3
34 Been thinking of yourself as a worth 0 1 2 3
less person
35 Been feeling reasonably happy, all 0 1 2 3
things
ACADEMIC PERFORMANCE SCALE (APS)

No Questions SA A N D SD
(Strongl (Agree) (Neutral) (Disagree) (Strongly
y Agree) Disagree
)
36 I make myself ready in all
my subjects
37 I pay attention and listen
during every
discussion
38 I want to get good grades
in every subject
39 I actively participate in
every discussion
40 I start papers and projects
as soon as they
are assigned
41 I enjoy homework and
activities because
they help me improve my
skills in every
subject
42 I exert more effort when I
do difficult
assignments
43 Solving problems is a
useful hobby for me