• Over the last 2 weeks, how often have you been bothered by any of the following problems?

  • 1. Feeling nervous, anxious or on edge:*
  • 2. Not being able to stop or control worrying:*

  • Over the last 2 weeks, how often have you been bothered by any of the following problems?

  • 3. Worrying too much about different things:*
  • 4. Trouble relaxing:*

  • Over the last 2 weeks, how often have you been bothered by any of the following problems?

  • 5. Being so restless that it is hard to sit still:*
  • 6. Becoming easily annoyed or irritable:*

  • Over the last 2 weeks, how often have you been bothered by any of the following problems?

  • 7. Feeling afraid as if something awful might happen:*

  • Gender (optional)
  • Should be Empty: