Request edit access
Panic Attack Survey
This survey is a voluntary, anonymous project among fellow panic attack sufferers. This is not intended to diagnose, treat, or prevent any disease or condition.

THIS IS NOT A RESEARCH STUDY

Your responses will be publicly accessible and any information/ stories you share maybe anonymously re-posted onto a peer support website in development (www.whenwepanic.com)

If you would prefer not to answer any questions, please use the "other" option and write "no answer"

Thank you for your participation! We're all in this together!
Sign in to Google to save your progress. Learn more
About how old were you when you experienced your first panic attack ?
 *
How often do you currently have panic attacks?
 *
What is your occupation?
 *
Required
Have you ever done any of the following in response to a panic attack?
 *
Required
Have you stopped doing any of the following in response to panic attacks?
 *
Required
What Symptoms Do You Experience During Panic Attacks?
 *
Required
What symptoms do you experience even when not having a full panic attack? Do you experience any of these symptoms at baseline or in general?
 *
Required
Under what circumstances do you believe your panic attacks are most likely to occur?
 *
Required
Has a medical professional diagnosed you or are you seeking evaluation for any of the following conditions? 

*** This is not intended to suggest you have any of these conditions, this is a list of conditions that I personally have worried about having/ do have ***

Have you engaged in any of the following activities to treat your panic?
Do you have a religious/spiritual/philosophical practice and if so what kind?
 *
Required
Have any of the following medications helped to decrease the severity and dysfunction of your panic?
 *
Required
Have any of the following supplements helped to manage symptoms?

*** Please do not take any of these without the advice and support of your primary care physician and checking with your pharmacist about potential interactions with other medications ***

 *
Required
What coping skills/activities have helped you manage symptoms?
 *
Required
Are there any questions you would like me to add to this survey?
What are some of your suggestions/ advice to others experiencing Panic Attacks/ Panic Disorder
If you want to share your story and experiences with other suffers, please write it here, and I will post it on the upcoming panic disorder website. Please try not to exceed 1000 words.

This story will be visible on the response pages of this form. It may also be resposted onto a panic disorder peer support website that is currently in development. 

Submitting your story implies permission to post this story
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms