Use slider to rate symptoms between 0 to 6

0=none, 1-2 = mild, 3-4 = moderate, 5-6 = severe

Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0
Selected Value: 0