Here are some questions about your health. Check either YES or NO to indicate your answer.
Click the button below to start.
Question 1 of 4
Have you experienced panic, high anxiety, and symptoms from that anxiety in the past month?
Question 2 of 4
Have you felt worried or anxious about having another panic attack or high anxiety episode?
Question 3 of 4
Below are symptoms experienced during a high anxiety attack or during panic. Please check off any symptoms that you have experienced during a recent high anxiety episode:
Palpitations, pounding heart, or accelerated heart rate
Chest pain or discomfort
Trembling or shaking
Sensations of shortness of breath or smothering
A feeling of choking or a lump in the throat
Rapid breathing or hyperventilating
Nausea or abdominal distress (churning in stomach)
Feeling dizzy, unsteady, lightheaded or faint
Feelings of unreality (derealization) or being detached from oneself (depersonalization)
Fear of losing control or going crazy
Numbness or tingling sensations
Chills, hot flushes
Feelings of dread or fear of dying
Question 4 of 4
Does your fear of having your high anxiety or panic symptoms interfere with your ability to work, do your school work, or carry out your responsibilities at home?