Anxiety & Stress Survey

Question Title

* 1. In the past 4 weeks, about how often did you feel tired out for no good reason?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 2. In the past 4 weeks, about how often did you feel nervous?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 3. In the past 4 weeks, about how often did you feel so nervous that nothing could calm you down?

A great deal

A lot

A moderate amount

A little

None at all

Question Title

* 4. In the past 4 weeks, about how often did you feel hopeless?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 5. In the past 4 weeks, about how often did you feel restless or fidgety?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 6. In the past 4 weeks, about how often did you feel so restless you could not sit still?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 7. In the past 4 weeks, about how often did you feel depressed?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 8. In the past 4 weeks, about how often did you feel that everything was an effort?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 9. In the past 4 weeks, about how often did you feel so sad that nothing could cheer you up?

Always

Usually

Sometimes

Rarely

Never

Question Title

* 10. In the past 4 weeks, about how often did you feel worthless?

A great deal

A lot

A moderate amount

A little

None at all