Welcome to this survey. Press Next to begin.

Please answer the following questions using the following scale:

• Not at all
• Several days
• More than half the days
• Nearly every day

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Feeling nervous, anxious or on edge?

Not at all Several days More than half the days Nearly every day

Not being able to stop or control worrying?

Not at all Several days More than half the days Nearly every day

Worrying too much about different things?

Not at all Several days More than half the days Nearly every day

Trouble relaxing?

Not at all Several days More than half the days Nearly every day

Being so restless that it is hard to sit still?

Not at all Several days More than half the days Nearly every day

Becoming easily annoyed or irritable?

Not at all Several days More than half the days Nearly every day

Feeling afraid as if something awful might happen?

Not at all Several days More than half the days Nearly every day

Congratulations for completing this survey! Press finish to continue.