INSTRUCTIONS: The following questions ask about thoughts, feelings, and behaviors, often tied to concerns about family, health, finances, school, and work. Please respond to each item by checking on box per row.

During the PAST 7 DAYS, I have: Never Occasionally Half of The Time Most of The Time All of The Time
Felt moments of sudden terror, fear, or fright
Felt anxious, worried or nervous
Had thoughts of bad things happening, such as family tragedy, ill health, loss of a job, or accidents
Felt a racing heart, sweaty, trouble breathing, faint or shaky
Avoided or did not approach or enter situations about which I worry
Left situations early or participated minimally due to worries
Spent lots of time making decisions, putting off making decisions, or preparing for situations, due to worries
Sought reassurance from others due to worries
Needed help to cope with anxiety (e.g. alcohol or medication, superstitious objects, or other people)