Mind Hamdard · Optional printable page
Use this optional page to describe capacity and practical demands, not to diagnose burnout or score your energy. You do not need a completed note before asking for care.
Privacy: print and write on paper, or use your own paper. This page has no answer fields and collects no entries. Leave names and sensitive details out, particularly on shared devices or printers.
Invented example: I used to follow a normal work email easily; now I reread it several times and miss instructions. I can ask for one priority in writing, describe when this changed, and arrange an assessment if the difficulty persists.
Which necessary activity is difficult, and what part asks too much right now?
Could any demand be delayed, simplified, shared, or removed safely? If not, what support is missing?
What specific request could I make, and to whom? Avoid private details if this page might be seen.
This is not a challenge to add activity, meet a step count, or make up for lost work.
What could I usually do, what is different now, and roughly when did it begin?
What should I mention about sleep, illness, medicines, or symptoms that become worse after ordinary activity?
What question or follow-up do I want to agree with the clinician?
Do not repeat an activity to prove that it makes you worse. Marked or delayed worsening deserves discussion; this note cannot identify its cause.
Fatigue that persists for weeks, has no clear explanation, affects daily life, or comes with other symptoms deserves medical assessment. Serious new chest or breathing symptoms, fainting, or sudden confusion need urgent medical help.