The Anxiety Relief Retreat New Student Profile Survey

1.How often do you experience anxiety?

All of the time, it's just always there

I feel anxious once or twice per day

I feel anxious about once or twice per week

I feel anxious about three or four times per year

2.Anxiety has physical, mental, and emotional symptoms that look and feel different to each of us. In just a few words, what does anxiety feel like to you?

3.Using the scale below, indicate how you feel about the following statement: “My anxiety prevents me from living my life the way I would like to.”

Strongly Agree

Agree Somewhat

Disagree Somewhat

Strongly Disagree

4.In your own words, how would your life look differently and feel differently if anxiety was less of a factor in your life?

5.In your own words, what would you say is your primary motivation for signing up for this retreat?

6.What do you believe is your biggest obstacle in your efforts to find relief from anxiety? (Choose one.)

Myself. (Choose this if you believe that your own level of self-knowledge, self-esteem, or self-worth is your biggest obstacle.)

Something else. (Choose this if you believe that a resource like time, money, or a lack of a support system is your biggest obstacle.)

Someone else. (Choose this if you believe that a specific person or group of persons is your biggest obstacle.)

Other (please provide more information)

7.What other tools and techniques have you tried in your efforts to find relief from anxiety? (Check all that apply.)

Other (please specify)

8.Where do you typically go to discover unique and helpful information - on any topic, not just anxiety relief - that you might share with friends? (Check all that apply.)

Other (please specify)