II. Questions: General (Answer Yes or No for each)

  1. In the last 4 weeks have you had an anxiety attack with sudden fear or panic?
  2. Has this ever happened before?
  3. Do some of these attacks come suddenly, out of the blue, in situations where you do not expect nervousness?
  4. Do these attacks bother you a lot or are you worried about haveing another attack?

III. Questions: Have you had these symptoms during your last bad anxiety episode (Answer Yes or No for each)

  1. Shortness of Breath?
  2. Heart racing, pounding, or skipping?
  3. Chest Pain or pressure?
  4. Sweating?
  5. Feeling as if you are Choking?
  6. Hot Flashes or chills?
  7. Nausea, upset Stomach or feeling that you were going to have Diarrhea?
  8. Dizzy, unsteady or faint?
  9. Tingling or numbness in parts of your body?
  10. Tremble or shake?
  11. Were you afraid of dying?

IV. Interpretation

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