Question Title * 1. Today's Date: Question Title * 2. Your First Name: Question Title * 3. Your Initials: Question Title * 4. Your age: Question Title * 5. Your Gender: Male Female Question Title * 6. Highest Level of Education: Primary School High School University Graduate Degree Question Title * 7. Your email address (will only be used for followup) : Question Title * 8. Your phone number (will only be used if we can not reach you through your email): Below is a list of problems and complaints that people sometimes have in response to stressful experiences. Please read each one carefully, and select the number that indicates how much you been bothered by that problem in the past month. Question Title * 9. Repeated, disturbing memories, thoughts, or images of a stressful experience? 1 = Not at all 2 = A little bit 3 = Moderately 4 = Quite a bit 5 = Extremely Question Title * 10. Feeling very upset when something reminded you of a stressful experience? 1 = Not at all 2 = A little bit 3 = Moderately 4 = Quite a bit 5 = Extremely Question Title * 11. Do you feel happy in general? Please choose a number: Not at all 0 1 2 3 4 5 6 7 8 9 10 Very 0 1 2 3 4 5 6 7 8 9 10 Question Title * 12. Please indicate the intensity of current, best, and worst pain levels over the past 24 hours on a scale of 0 (no pain) to 10 (worst pain imaginable) 0 1 2 3 4 5 6 7 8 9 10 Next
