Have you used alcohol, illegal substances or drugs recently, which caused problems at work/school or with loved ones?

A. I never had this issue
B. I rarely experienced this
C. Sometimes, I experienced it
D. I experienced it often
E. I experienced it very often

Do you experience shortness of breath, sweaty palms and/or racing heart at a particular situation/object for no apparent reason?

A. I never feel this
B. I rarely feel this
C. Sometimes, I feel it
D. I feel it often
E. I feel it very often

Are you troubled by fear of objects/animals/situations where getting help or escaping may seem difficult?

A. I never have this issue
B. I rarely have this issue
C. I sometimes have this issue
D. I often have this issue
E. I very often have this issue

Are you so troubled at the thought of public speaking that you have turned down promotions or jobs?

A. I never have this issue
B. I rarely have this issue
C. I sometimes have this issue
D. I often have this issue
E. I very often have this issue

Do you feel so anxious that your face turns red, your heart races and your voice cracks because you feel people are staring at you?

A. Never
B. Very rarely
C. Few times a month
D. At least once every week
E. Every other day

Do you fear that your actions will embarrass you or that you will humiliate yourself in front of others?

A. I never feel like this
B. I rarely feel like this
C. I sometimes feels like this
D. I often feel like this
E. I very often feel like this

Do you like the idea of travelling by sea or air? Do you get scared by the mention of travel by air or sea?

A. I never feel like this
B. I rarely feel like this
C. I sometimes feels like this
D. I often feel like this
E. I very often feel like this