New Mentality Health Questionnaire

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Feeling nervous, anxious or on edge

Not at all (0)

Several days (1)

More than half the days (2)

Nearly every day (3)

Not being able to stop or control worrying

Not at all (0)

Several days (1)

More than half the days (2)

Nearly every day (3)

Worrying too much about different things.....

Not at all (0)

Several days (1)

More than half the days (2)

Nearly every day (3)

Trouble relaxing......

Not at all (0)

Several days (1)

More than half the days (2)

Nearly every day (3)

Being so restless that it is hard to sit still.......

Not at all (0)

Several days (1)

More than half the days (2)

Nearly every day (3)

Becoming easily annoyed or irritable.....

Not at all (0)

Several days (1)

More than half the days (2)

Nearly every day (3)

Feeling afraid as if something awful might happen.....

Not at all (0)

Several days (1)

More than half the days (2)

Nearly every day (3)

Questions about anxiety attacks

In the last 4 weeks, have you had an anxiety attack----suddenly feeling fear or panic?

No

Yes