Panic Disorder Questionnaire
Panic Attack Symptoms *
A Panic Attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. Mark any symptoms you might have in an abrupt surge of anxiety:
Required
Have you had 1 month or more of: *
Check all that apply.
Required
How frequently do you have panic attacks? *
How much distress (bother) do you experience during panic attacks? *
How much anxiety do you feel in anticipation of future attacks *
To what extent do you avoid particular situations because you fear having a panic attack in that situation? *
To what extent do you avoid particular sensations because you fear having a panic attack? *
To what extent do panic attacks impair or interfere in work functioning? *
To what extent do panic attacks impair or interfere in social functioning? *
Name
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Email *
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Phone
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