Over the last two weeks, how often have you been bothered by the following problems?(在过去2周里,您被以下问题困扰的频率如何?)
Sign in to Google to save your progress. Learn more
Name(名字) *
Today's Date(今天日期) *
1. Feeling nervous, anxious or on edge(感觉紧张、焦虑或不安) *
2. Not being able to stop or control worrying(无法停止或控制担忧) *
3. Worrying too much about different things(对各种事情担心太多)
Clear selection
4. Trouble relaxing(难以放松)
Clear selection
5. Being so restless that it is hard to sit still(坐立不安,以至于很难安静地坐下来)
Clear selection
6. Being easily annoyed or irritable(变得容易生气或急躁)
Clear selection
7. Feeling afraid as if something awful might happen(感觉害怕,好像有可怕的事情要发生一样)
Clear selection
Clear form
Never submit passwords through Google Forms.
This form was created inside of Amaranth Pediatrics. Report Abuse