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Please Check All That Apply
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Feel sad
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Muscle aches
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Loss of interest
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Feel 'on edge'
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Feel hopeless
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Worrying too much
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Nothing Is fun
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Impatient
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Weight loss
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Dry mouth
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No energy
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Bowel problems
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Cry easily
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Hyperventilation
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Can't concentrate
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Fainting/Dissiness
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Can't fall asleep
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Pounding heart
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Sleep too much
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Trembling
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Guilt feelings
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Sweating
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Restless
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Choking sensations
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Irritable mood
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Nausea
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Thoughts of suicide
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Numbness/Tingling
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Waking up early
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Chest pain
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Feel worse in the morning
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Fear of dying
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No need for sleep
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Fear of going crazy
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Talking too much
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Can't pay attention
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Racing thoughts
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Can't finish what you want
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Buying/Spending sprees
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Easily distracted
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Reckless driving
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Fidgeting
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Overactive sexually
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Interrupts others
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Uncontrollable urges
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Feel fear or anxiety of:
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Explosive temper
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Crowds
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Gambling too much
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Bridges
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Drinking too much
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Buses
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Sexually abused
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Stores
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Physically abused
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Being out of the house
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Flashbacks
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Heights
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Nightmares
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Talking in public
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Feeling numb
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Choking on food
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Startle response
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Urinating in public
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