Request edit access
Light on Anxiety Brief Symptom & Functional Assessment
Light on Anxiety strives to provide you with short term relief and long term improvements in functioning and life satisfaction. In order to assess if we are helping you to decrease anxiety and related symptoms, please take a few moments to complete the form below.
Last Name *
Your answer
First Name *
Your answer
In the past week, on average, how much emotional distress and discomfort did you (or your child) experience?
Low
High
In the past week, on average, how much did your anxiety and related symptoms impact your (or your child’s) functioning?
Low
High
In the past week, on average, how would you rate your (or your child’s) overall life satisfaction?
Low
High
Submit
Never submit passwords through Google Forms.
This form was created inside of Light on Anxiety. Report Abuse - Terms of Service