Neurobehavioral Symptom Inventory (NSI)

Please rate how much each symptom has disturbed you in the last 2 weeks.

Your Information

Name

Date completed

Instructions

Please rate the following symptoms with regard to how much they have disturbed you in the last 2 weeks. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.

0 = None
Rarely if ever present; not a problem at all.

1 = Mild
Occasionally present; does not disrupt activities.

2 = Moderate
Often present; occasionally disrupts activities.

3 = Severe
Frequently present and disrupts activities.

4 = Very Severe
Almost always present; unable to perform at work, school, or home.

Additional Notes

Did someone help you complete this form?

Comments about your symptoms or anything you want your care team to know

Results are automatically emailed to the clinic-designated assessment email after scoring.

Results

Interpretation note: The NSI total score is the sum of all 22 symptom ratings. Higher scores indicate greater symptom burden. Symptom cluster scores are included to support clinical review and tracking, not to diagnose.