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Q.1
Over the last three months, have you felt excessively worried for more days than not?
*
Yes
No
Q.2
Has the worry you felt often seemed “irrational,” or out of proportion with the situation, but beyond your control to “reason away?”
*
Yes
No
Q.3
Have there been times you couldn’t identify what exactly was causing your anxiety?
*
Yes
No
Q.4
Have you had trouble falling or staying asleep?
*
Yes
No
Q.5
Have you felt more tired than usual, even on days when you got adequate sleep?
*
Yes
No
Q.6
Have you had more difficulty concentrating on work or school than usual?
*
Yes
No
Q.7
Have you felt “keyed up,” “on edge,” or unusually tense more often than not?
*
Yes
No
Q.8
When you’ve felt worried over the past three months, have you experienced tightness in your chest, shortness of breath, a pounding heart, or a feeling of choking?
*
Yes
No
Q.9
Over a three-month span, have you experienced persistent muscle tension or muscle aches without any increased or altered physical activity that might explain it?
*
Yes
No
Q.10
Over a three-month span, have you experienced persistent nausea, diarrhea, or irritable bowel syndrome without any dietary changes that might explain it?
*
Yes
No
Q.11
Have you felt shaky or wobbly, experienced numbness or tingling in your body, or had chills or hot flashes while feeling anxious?
*
Yes
No
Q.12
Have you found yourself avoiding situations that you think may cause more anxiety?
*
Yes
No
Q.13
Over the last year, has your use of drugs or alcohol negatively impacted your home or work life, yet persisted regardless?
*
Yes
No
Q.14
Have you been unusually irritable?
*
Yes
No
Q.15
Do you find it difficult to "shut off" or disengage from worry, (even at times when the worry seems initially warranted)?
*
Yes
No
Q.16
Do you find it is difficult to soothe or "come down" from the worry/anxiety, even after the thing you are worried about seems resolved?
*
Yes
No
Q.17
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