Anxiety

Interested in participating in an anxiety study?

Fill out the form below to see if you qualify.

First Name*

Last Name*

Email*

Phone Number*

​Do you have a lot of anxiety or spend a lot of time worrying?
yesno

​How long have you been feeling this way?

Have you been feeling this way more days than not over the past 6 months?
yesno

​Have you ever had a panic attack when you suddenly felt scared or anxious?
yesno

Do you have problems sleeping or concentrating?
yesno

​Do you have a lot of muscle tension?
yesno

​​Do you feel restless or on edge?
yesno

Do you get embarrassed or uncomfortable when meeting people or being the center of attention?
yesno

Do you consider hurting yourself, feel suicidal, or wish that you were dead?
yesno

​Have you had any suicide attempts in the past?
yesno

- If yes, when did this occur?

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