* 1. Being Criticized Scares Me

* 2. I Worry About What Other People Think Of Me

* 3. Are You A Man Or A Woman?

* 4. What Is Your #1 Biggest Challenge With Social Anxiety Right Now? (Write as much detail as possible)

* 5. I Avoid Speaking For Fear Of Embarrassment

* 6. What Is Your #1 Challenge With Conversations Right Now? (Provide As Much Detail As Possible)

* 7. I Struggle Most With

* 8. What Is Your Email?

* 9. What is your Phone Number? (Optional)
(I occasionally connect with people to find out more about their situation)