Freespira Symptom Quiz

1
Panic attacks and trauma symptoms can have lasting effects on your mental health and quality of life. Take this quiz to see if Freespira can help with your symptoms.

{headertext} {pst} insurance.

Disclaimer: This quiz is not a diagnostic tool or substitute for professional mental health advice. It is to determine if Freespira may be right for you and your symptoms.
2
What is your name?* This field is required.We need to collect your information to share your results with you.
First Name
Preferred Name
Last Name
3
What is your email address?* This field is required.
example@example.com
4
What is your mobile phone number?* This field is required.By sharing your number, you agree to receive calls or texts at this number. You may withdraw at any time by replying STOP to a text message.
Please enter a valid phone number.
5
What is the name of your health insurance?
Security Health Plan
Chorus Community Health Plans
Highmark
Other
6
What is your date of birth? * This field is required.
Date
Month
Day
Year
7
Which symptoms would you like to check?
Panic Attacks/Anxiety Attacks
PTSD/Trauma
8
The following questions refer to panic attacks and limited-symptom attacks. For this questionnaire, we define a panic attack as a sudden rush of fear or discomfort accompanied by at least four symptoms. The symptoms must peak within 10 minutes to qualify as a sudden rush. Episodes like panic attacks but having fewer than four symptoms are called limited-symptom attacks.
9
Do you experience panic attacks?* This field is required.
Yes
No
10
Do you experience any of the following symptoms? Please select all that apply.* This field is required.
Rapid or pounding heartbeat
Chest pain or discomfort
Chills or hot flushes
Sweating
Nausea
Fear of losing control or going crazy
Trembling or shaking
Dizziness or faintness
Breathlessness
Feeling of unreality
Fear of dying
Feeling of choking
Numbness or tingling
None
11
How many panic attacks or limited-symptom attacks did you have during the past month?* This field is required.
No panic or limited-symptom attacks
Mild: No full panic attacks and no more than 1 limited-symptom attack per day
Moderate: 1or 2 full panic attacks and/or multiple limited-symptom attacks per day
Severe: More than 2 full attacks but not more than per day on average
Extreme: Full panic attacks occurred more than once a day, more days than not
12
If you had any panic attacks during the past month, how distressing (uncomfortable, frightening) were they while they were happening?* This field is required.
Not at all distressing, or no panic or limited-symptom attacks during the past month
Mild: Distressing (not too intense)
Moderate: Distressing (intense, but still manageable)
Severe: Distressing (very intense)
Extreme: Distressing (extreme distress during all attacks)
13
During the past month, how much have you worried or felt anxious about when your next panic attack would occur or about fears related to the attacks?* This field is required.
Not at all
Occasionally or only mildly
Frequently or moderately
Very often or to a very disturbing degree
Nearly constantly and to a disabling extent
14
During the past month, were there any places or situations you avoided, or felt afraid of, because of fear of having a panic attack?* This field is required.
No fear or avoidance
Mild: Occasional fear and/or avoidance but I could usually confront or endure the situation. There was little or no modification of my lifestyle due to this.
Moderate: Noticeable fear and/or avoidance but still manageable. I avoided some situations, but I could confront them with a companion. There was some modification of my lifestyle because of this, but my overall functioning was not impaired.
Severe: Extensive avoidance. Substantial modification of my lifestyle was required to accommodate the avoidance. making it difficult to manage usual activities.
Extreme: Pervasive disabling fear and/or avoidance. Extensive modification in my lifestyle was required such that important tasks were not performed.
15
During the past month, were there any activities that you avoided or felt afraid of because they caused physical sensations like those you feel during panic attacks or that you were afraid might trigger a panic attack?* This field is required.
No fear or avoidance of situations or activities because of distressing physical sensations
Mild: Occasional fear and/or avoidance, but usually I could confront or endure with little distress activities that cause physical sensations. There was little modification of my lifestyle due to this.
Moderate: Noticeable avoidance but still manageable. There was definite, but limited, modification of my lifestyle such that my overall functioning was not impaired.
Severe: Extensive avoidance. There was substantial modification of my lifestyle or interference in my functioning.
Extreme: Pervasive and disabling avoidance. There was extensive modification in my lifestyle due to this such that important tasks or activities were not performed.
16
During the past month, how much did your symptoms interfere with your ability to work or carry out your responsibilities at home or school?* This field is required.
No interference
Slight interference with social activities, but I could do nearly everything I could if I didn’t have these problems.
Significant interference with social activities, but I could manage to do most things if I made the effort.
Substantial impairment in social activities; there were many social things I couldn’t do because of these problems.
Extreme, incapacitating impairment, such that there was hardly anything social I could do.
17
During the past month, how much did panic and limited symptom attacks or worry about attacks interfere with your social life?* This field is required.
No interference
Slight interference with social activities, but I could do nearly everything I could if I didn’t have these problems.
Significant interference with social activities, but I could manage to do most things if I made the effort.
Substantial impairment in social activities; there were many social things I couldn’t do because of these problems.
Extreme, incapacitating impairment, such that there was hardly anything social I could do.
18
Have you been diagnosed with post-traumatic stress disorder?* This field is required.
YESNO
19
The following symptoms can be in response to a very stressful experience.

Please select the answer that best indicates how much you have been bothered by that problem in the past month.
20
Repeated, disturbing, and unwanted memories of the stressful experience* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
21
Repeated, disturbing dreams of the stressful experience* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
22
Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
23
Feeling very upset when something reminded you of the stressful experience* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
24
Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
25
Avoiding memories, thoughts, or feelings related to the stressful experience* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
26
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
27
Trouble remembering important parts of the stressful experience* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
28
Having strong negative beliefs about yourself, other people, or the world (e.g., having thoughts such as, "I am bad," "there is something seriously wrong with me," "no one can be trusted," "the world is completely dangerous," etc.* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
29
Blaming yourself or someone else for the stressful experience or what happened after it* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
30
Having strong negative feelings such as fear, horror, anger, guilt, or shame* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
31
Loss of interest in activities that you used to enjoy* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
32
Feeling distant or cut off from other people* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
33
Trouble experiencing positive feelings (e.g., being unable to feel happiness or have loving feelings for people close to you)* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
34
Irritable behavior, angry outbursts, or acting aggressively* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
35
Taking too many risks or doing things that could cause you harm* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
36
Being “superalert” or watchful or on guard* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
37
Feeling jumpy or easily startled* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
38
Having difficulty concentrating* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
39
Trouble falling or staying asleep* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
40
The following symptoms can be in response to a very stressful experience. Keeping your worst event in mind, please read each problem carefully and select the answer that best indicates how much you have been bothered by that problem in the past month.
Not at all
A little bit
Moderate
Quite a bit
Extreme
Repeated, disturbing, and unwanted memories of the stressful experience?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Repeated, disturbing dreams of the stressful experience?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Feeling very upset when something reminded you of the stressful experience?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Avoiding memories, thoughts, or feelings related to the stressful experience?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Trouble remembering important parts of the stressful experience?
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Blaming yourself or someone else for the stressful experience or what happened after it?
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Having strong negative feelings such as fear, horror, anger, guilt, or shame?
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Loss of interest in activities that you used to enjoy?
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Feeling distant or cut off from other people?
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
Row 13, Column 0
Row 13, Column 1
Row 13, Column 2
Row 13, Column 3
Row 13, Column 4
Irritable behavior, angry outbursts, or acting aggressively?
Row 14, Column 0
Row 14, Column 1
Row 14, Column 2
Row 14, Column 3
Row 14, Column 4
Taking too many risks or doing things that could cause you harm?
Row 15, Column 0
Row 15, Column 1
Row 15, Column 2
Row 15, Column 3
Row 15, Column 4
Being 'super-alert' or watchful or on guard?
Row 16, Column 0
Row 16, Column 1
Row 16, Column 2
Row 16, Column 3
Row 16, Column 4
Feeling jumpy or easily startled?
Row 17, Column 0
Row 17, Column 1
Row 17, Column 2
Row 17, Column 3
Row 17, Column 4
Having difficulty concentrating?
Row 18, Column 0
Row 18, Column 1
Row 18, Column 2
Row 18, Column 3
Row 18, Column 4
Trouble falling or staying asleep?
Row 19, Column 0
Row 19, Column 1
Row 19, Column 2
Row 19, Column 3
Row 19, Column 4
Repeated, disturbing, and unwanted memories of the stressful experience?
Repeated, disturbing dreams of the stressful experience?
Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
Feeling very upset when something reminded you of the stressful experience?
Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
Avoiding memories, thoughts, or feelings related to the stressful experience?
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
Trouble remembering important parts of the stressful experience?
Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
Blaming yourself or someone else for the stressful experience or what happened after it?
Having strong negative feelings such as fear, horror, anger, guilt, or shame?
Loss of interest in activities that you used to enjoy?
Feeling distant or cut off from other people?
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
Irritable behavior, angry outbursts, or acting aggressively?
Taking too many risks or doing things that could cause you harm?
Being 'super-alert' or watchful or on guard?
Feeling jumpy or easily startled?
Having difficulty concentrating?
Trouble falling or staying asleep?
Not at all
Row 0, Column 0
A little bit
Row 0, Column 1
Moderate
Row 0, Column 2
Quite a bit
Row 0, Column 3
Extreme
Row 0, Column 4
Not at all
Row 1, Column 0
A little bit
Row 1, Column 1
Moderate
Row 1, Column 2
Quite a bit
Row 1, Column 3
Extreme
Row 1, Column 4
Not at all
Row 2, Column 0
A little bit
Row 2, Column 1
Moderate
Row 2, Column 2
Quite a bit
Row 2, Column 3
Extreme
Row 2, Column 4
Not at all
Row 3, Column 0
A little bit
Row 3, Column 1
Moderate
Row 3, Column 2
Quite a bit
Row 3, Column 3
Extreme
Row 3, Column 4
Not at all
Row 4, Column 0
A little bit
Row 4, Column 1
Moderate
Row 4, Column 2
Quite a bit
Row 4, Column 3
Extreme
Row 4, Column 4
Not at all
Row 5, Column 0
A little bit
Row 5, Column 1
Moderate
Row 5, Column 2
Quite a bit
Row 5, Column 3
Extreme
Row 5, Column 4
Not at all
Row 6, Column 0
A little bit
Row 6, Column 1
Moderate
Row 6, Column 2
Quite a bit
Row 6, Column 3
Extreme
Row 6, Column 4
Not at all
Row 7, Column 0
A little bit
Row 7, Column 1
Moderate
Row 7, Column 2
Quite a bit
Row 7, Column 3
Extreme
Row 7, Column 4
Not at all
Row 8, Column 0
A little bit
Row 8, Column 1
Moderate
Row 8, Column 2
Quite a bit
Row 8, Column 3
Extreme
Row 8, Column 4
Not at all
Row 9, Column 0
A little bit
Row 9, Column 1
Moderate
Row 9, Column 2
Quite a bit
Row 9, Column 3
Extreme
Row 9, Column 4
Not at all
Row 10, Column 0
A little bit
Row 10, Column 1
Moderate
Row 10, Column 2
Quite a bit
Row 10, Column 3
Extreme
Row 10, Column 4
Not at all
Row 11, Column 0
A little bit
Row 11, Column 1
Moderate
Row 11, Column 2
Quite a bit
Row 11, Column 3
Extreme
Row 11, Column 4
Not at all
Row 12, Column 0
A little bit
Row 12, Column 1
Moderate
Row 12, Column 2
Quite a bit
Row 12, Column 3
Extreme
Row 12, Column 4
Not at all
Row 13, Column 0
A little bit
Row 13, Column 1
Moderate
Row 13, Column 2
Quite a bit
Row 13, Column 3
Extreme
Row 13, Column 4
Not at all
Row 14, Column 0
A little bit
Row 14, Column 1
Moderate
Row 14, Column 2
Quite a bit
Row 14, Column 3
Extreme
Row 14, Column 4
Not at all
Row 15, Column 0
A little bit
Row 15, Column 1
Moderate
Row 15, Column 2
Quite a bit
Row 15, Column 3
Extreme
Row 15, Column 4
Not at all
Row 16, Column 0
A little bit
Row 16, Column 1
Moderate
Row 16, Column 2
Quite a bit
Row 16, Column 3
Extreme
Row 16, Column 4
Not at all
Row 17, Column 0
A little bit
Row 17, Column 1
Moderate
Row 17, Column 2
Quite a bit
Row 17, Column 3
Extreme
Row 17, Column 4
Not at all
Row 18, Column 0
A little bit
Row 18, Column 1
Moderate
Row 18, Column 2
Quite a bit
Row 18, Column 3
Extreme
Row 18, Column 4
Not at all
Row 19, Column 0
A little bit
Row 19, Column 1
Moderate
Row 19, Column 2
Quite a bit
Row 19, Column 3
Extreme
Row 19, Column 4
1 of 20
41
Your Quiz Results Are Here!

Freespira may help with your symptoms.

In fact, it’s helped thousands get fast, long-lasting relief from their panic attacks and trauma symptoms—right from the comfort of home. In just 28 days, you’ll learn to regain control of your breathing, body, and symptoms.
42
Your Quiz Results Are Here!

Freespira may help with your symptoms.

In fact, it’s helped thousands get fast, long-lasting relief from their panic attacks and trauma symptoms—right from the comfort of home. In just 28 days, you’ll learn to regain control of your breathing, body, and symptoms.
43
Ready to take the next step? Choose how you’d like to enroll:{startTreatment} {pst} {insuranceOr}
Enroll Now
Need more info before you enroll? We understand, click here to learn more.
44
Would you like to schedule a 15-minute call?Freespira may be covered by your insurance {pst}, with no out-of-pocket costs or copays.
YESNO
45
Can you tell us why you’d like to wait to enroll in treatment?
I don’t have time to commit to two 17-minute sessions for 28 days.
I want to learn more about the treatment.
Other
46
Can you tell us why you’d like to wait to schedule a call?
I'd rather enroll online.
I want to learn more about the treatment.
Other
47
Curious to know what our device looks like?Once you're enrolled, you'll receive a kit. Each kit includes a breathing sensor that monitors your breathing during sessions. With this feedback, you'll be able to adjust your breathing patterns over 28 days to experience long-lasting relief.
48
Did you know?

Freespira has helped more than 7,000 patients who have suffered from panic/anxiety attacks and PTSD symptoms. Unlike many treatments, Freespira is medication-free and is completed on your schedule. In a study, 9 out of 10 patients:

Were panic attack-free immediately after treatment

Experienced long-lasting symptom relief

Would recommend Freespira to a friend or family member
49
Hear how Freespira changed Olivia's life.
50
Hear how Freespira changed Sarah's life.
51
We understand. Life gets busy, and your time is important. Here's what one patient said after completing Freespira:

"In the beginning, I didn't think this would work. Now I really see the benefits. I’m able to think more clearly. The rapid thoughts that used to distract me are gone. My stressors aren't in charge of me anymore." — Freespira patient

The treatment can be done right at home with equipment shipped right to you. Best of all, treatment is complete after 28 days — no long-term commitment.
52
Are you ready to enroll in treatment and start living your life the way you want?{headertext} {pst} {insuranceOr}
YESNO
53
No problem. We’ll email you some materials, including answers to common questions, how Freespira differs from other treatments (including breathing exercises), and other helpful resources. Once you’re ready to move forward, let us know, and we’ll help you get started with treatment.If you have any questions, please let us know below. Otherwise, select "Submit."
54
Great, thank you! One of our Care Advisors will follow up with you in 24-48 hours. Please click the button below to end this quiz.
55
Great! There are two ways to sign up. Which would you prefer?
Schedule a Call – Talk with a Care Advisor to complete your enrollment and get your questions answered.
Enroll Online – Quick and easy, get started in minutes
56
Great! Click "Submit" below to schedule your call when it’s most convenient. A care advisor will then call you at that time.
57
Great! Click "Submit" to continue enrolling online. Once you click the button, you’ll answer the remaining questions to ensure your enrollment is complete. The process should take 5 minutes.
58
How did you hear about Freespira?
Please Select
Please Select
Billboard Ad
Blog
Bus Ads
Case Manager
Clinician/Provider
Community Event
Direct Mailer
Email
Facebook Ads
Google Ads
Google Search
LinkedIn Ads
News Media
Newsletter
Other
Phone Call
SMS Message
Social Media
Webinar
Word of Mouth
59
Lead Source Detail
60
Disease state
Panic
PTSD
61
UTM Source
62
UTM Term
63
UTM Campaign
64
utmcampaign
65
UTM Content
66
UTM Medium
67
UTM Medium
68
UTM Medium
69
PDSS Score
70
PCL5 Score
71
symptom count
72
symptoms api* This field is required.
PDSS_S01
PDSS_S06
PDSS_S11
PDSS_S02
PDSS_S07
PDSS_S12
PDSS_S03
PDSS_S08
PDSS_S04
PDSS_S09
PDSS_S13
PDSS_S05
PDSS_S10
73
PDSS Q1
74
PDSS Q2
75
PDSS Q3
76
PDSS Q4
77
PDSS Q5
78
PDSS Q6
79
PDSS Q7
80
PCL5 Q1
81
PCL5 Q2
82
PCL5 Q3
83
PCL5 Q4
84
PCL5 Q5
85
PCL5 Q6
86
PCL5 Q7
87
PCL5 Q8
88
PCL5 Q9
89
PCL5 Q10
90
PCL5 Q11
91
PCL5 Q12
92
PCL5 Q13
93
PCL5 Q14
94
PCL5 Q15
95
PCL5 Q16
96
PCL5 Q17
97
PCL5 Q18
98
PCL5 Q19
99
PCL5 Q20
100
PDSS Name
101
PCL5 Name
102
lead type
Hot
Warm
103
payment source text
104
headertext
If your symptoms qualify, Freespira may be covered by your
Please Select
If your symptoms qualify, Freespira may be covered by your
Freespira is available at no cost for eligible members of
105
start treatment covered or not
Freespira may be covered by your insurance
Please Select
Freespira may be covered by your insurance
Freespira is available to you at no cost
106
insurance or say no copay or OOP for CCHP/SHP
Insurance
Please Select
Insurance
with no out of pockets or copays
107
account id
108
Should be Empty: