Anxiety	Never	Rarely	Sometimes	Often	Always
In the past 7 days…
I felt fearful	□ 1	□ 2	□ 3	□ 4	□ 5
I found it hard to focus on anything other than my anxiety	□ 1	□ 2	□ 3	□ 4	□ 5
My worries overwhelmed me	□ 1	□ 2	□ 3	□ 4	□ 5
I felt uneasy	□ 1	□ 2	□ 3	□ 4	□ 5