Anxiety Survey.Please answer all items. Your answers will be e-mailed to Karin Kramer and kept confidential. Your ID Number (as assigned by Karin) I worry about things a lot. Not at all true Slightly true Moderately true Very true Completely true I tend to worry all day long. Not at all true Slightly true Moderately true Very true Completely true I've been worrying about things more days than not for the past six months. Not at all true Slightly true Moderately true Very true Completely true The worrying is upsetting to me. Not at all true Slightly true Moderately true Very true Completely true The worrying makes it hard for me to relax and enjoy life. Not at all true Slightly true Moderately true Very true Completely true In the PAST TWO WEEKS, I've been feeling anxious. Not at all Slightly Moderately Very Extremely In the PAST TWO WEEKS, I've been feeling nervous. Not at all Slightly Moderately Very Extremely In the PAST TWO WEEKS, I've been feeling worried. Not at all Slightly Moderately Very Extremely In the PAST TWO WEEKS, I've been feeling frightened or apprehensive. Not at all Slightly Moderately Very Extremely In the PAST TWO WEEKS, I've been feeling tense or on edge. Not at all Slightly Moderately Very Extremely When you're anxious, how STRONG are your symptoms of a skipping, racing, or pounding heart? Not at all Slightly Moderately Very Extremely When you're anxious, how STRONG are your symptoms of sweating, chills or hot flushes.? Not at all Slightly Moderately Very Extremely When you're anxious, how STRONG are your symptoms of trembling or shaking? Not at all Slightly Moderately Very Extremely When you're anxious, how STRONG are your symptoms of shortness of breath or difficulty breathing? Not at all Slightly Moderately Very Extremely When you're anxious, how STRONG are your symptoms of dizziness, lightheadedness, or feeling off-balance? Not at all Slightly Moderately Very Extremely Thank you!
