How often did you feel nervous, anxious, or on edge during the last 2 weeks?
Never
Sometimes (1-4 times)
Often (5-10 times)
Regularly (over 10 times)
Over the past 2 weeks, how much has your anxiety/worry interfered with your life, work, social activities, family, etc.?
Never
Sometimes
Often
Regularly
What are your main causes of anxiety during the last 2 weeks?
Work
Family
Financial security
Health
Other people
Learning/School
Moving
Relationships
Traumatic event
World news
Other
Nothing
What physical symptoms of anxiety have you felt?
Stomach pain, nausea, or digestive trouble
Headache
Rapid breathing or shortness of breath
Pounding heart or increased heart rate
Sweating
Trembling or shaking
Other
None
What else have you experienced in the last 2 weeks?
Inability to relax/feeling agitated
Weakness or feel fatigued
Hard to concentrate
Increased irritability
Insomnia or other sleep issues (e.g., waking up frequently)
Muscle tension or pain
Panic attacks
Other
None
How often did you feel down, depressed, or hopeless during the last 2 weeks?
Never
Sometimes
Often
Regularly
How often did you feel anxious or panicky before social situations (e.g., talk to people, doing something in front of others)?
Never
Sometimes
Often
Regularly
You tend to worry more about…
things working out in the future
things that have already happened in the past
How do you usually relieve stress?
Do sports or move more
Talk to friends and family
Meditate
Cry
Work
Do something creative
Watch something enjoyable
Other
What is your name or pseudonym?
If you dont feel comfortable sharing your name, please make up a pseudonym.
Required field
Please enter a valid email address
Please enter a valid name
Get results
Required field
Please enter a valid email address
Please enter a valid name