Questionnaire for Anxiety Clinical Trial

Questionnaire for Anxiety Clinical Trial
Acid foods upset

Yes No
Get chilled often

Yes No
Lump in throat

Yes No
Dry mouth/eyes/nose

Yes No
Keyed up, fail to calm

Yes No
Strong light irritates

Yes No
Heart pounds after retiring

Yes No
Nervous stomach

Yes No
Cold sweats often

Yes No
Staring/blinks little

Yes No
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm