Freespira Symptom Quiz

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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.

If your symptoms qualify, you can access our at-home treatment at no extra cost. It’s fully covered by {pst}.

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.
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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 your date of birth? * This field is required.
Date
Month
Day
Year
6
Which symptoms would you like to check?
Panic Attacks/Anxiety Attacks
PTSD/Trauma
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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.
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Do you experience panic attacks?* This field is required.
Yes
No
9
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
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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
11
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)
12
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
13
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.
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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.
15
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.
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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.
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Have you been diagnosed with post-traumatic stress disorder?* This field is required.
YESNO
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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.
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Repeated, disturbing, and unwanted memories of the stressful experience* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
20
Repeated, disturbing dreams of the stressful experience* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
21
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
22
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
23
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
24
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
25
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
26
Trouble remembering important parts of the stressful experience* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
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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
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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
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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
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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
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Feeling distant or cut off from other people* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
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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
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Irritable behavior, angry outbursts, or acting aggressively* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
34
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
35
Being “superalert” or watchful or on guard* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
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Feeling jumpy or easily startled* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
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Having difficulty concentrating* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
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Trouble falling or staying asleep* This field is required.
Not at all
A little bit
Moderately
Quite a bit
Extremely
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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
40
Great news! Freespira may help with your symptoms. In fact, it’s helped thousands like you get fast, long-lasting relief from their panic attacks and trauma symptoms—right from the comfort of home. In 28 days, you’ll learn to regain control of your breathing, body, and symptoms.
41
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 28 days, you’ll learn to regain control of your breathing, body, and symptoms.
42
Are you ready to sign up for treatment?Freespira is completely covered by {pst}, with no out-of-pocket costs or copays.
Yes
No
I'm not sure
43
Would you like to schedule a 15-minute call?Freespira is completely covered by {pst}, with no out-of-pocket costs or copays.
YESNO
44
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
45
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
46
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.
47
Are you ready to enroll in treatment and start living your life the way you want?Freespira is fully covered by {pst}, with no out-of-pocket costs or copays.
YESNO
48
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."
49
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.
50
Great! There are two ways to sign up. Which would you prefer?
Schedule a call with a Care Advisor to complete enrollment
Enroll online
51
Great! Click "Submit" below to schedule your call when it’s most convenient. A care advisor will then call you at that time.
52
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.
53
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
54
Lead Source Detail
55
Disease state
Panic
PTSD
56
UTM Source
57
UTM Term
58
UTM Campaign
59
utmcampaign
60
UTM Content
61
UTM Medium
62
UTM Medium
63
PDSS Score
64
PCL5 Score
65
symptom count
66
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
67
PDSS Q1
68
PDSS Q2
69
PDSS Q3
70
PDSS Q4
71
PDSS Q5
72
PDSS Q6
73
PDSS Q7
74
PCL5 Q1
75
PCL5 Q2
76
PCL5 Q3
77
PCL5 Q4
78
PCL5 Q5
79
PCL5 Q6
80
PCL5 Q7
81
PCL5 Q8
82
PCL5 Q9
83
PCL5 Q10
84
PCL5 Q11
85
PCL5 Q12
86
PCL5 Q13
87
PCL5 Q14
88
PCL5 Q15
89
PCL5 Q16
90
PCL5 Q17
91
PCL5 Q18
92
PCL5 Q19
93
PCL5 Q20
94
PDSS Name
95
PCL5 Name
96
lead type
Hot
Warm
97
payment source text
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