When you are nervous or afraid, do you have episodes where you experience uncontrollable trembling or shaking?

A. No
B. Yes

Do you become afraid when you feel sick to your stomach, nauseous, bloated, or experience abdominal distress for no apparent reason?

A. No
B. Yes

Do you get sweating if you are afraid of something?

A. No
B. Yes

Do you feel shortness of breath if you are afraid?

A. No
B. Yes

Do you have any anxiety (feeling anxious, nervous or fearful)?

A. No
B. Yes

I am no longer able to drive at all, due to fear of accident.

A. No
B. Yes

Have you had any chills (wrapped in blankets feeling cold)?

A. Yes
B. No

Do you feel the chest pain?

A. Yes
B. No

Do you have episodes where you are afraid that you may lose control?

A. No
B. Yes

Do you have fear of dying?

A. No
B. Yes

I avoid exercising because I am afraid it will cause me to have a panic attack.

A. No
B. Yes

Have you had any flushing episodes (like redness in the face)?

A. Yes
B. No