* 1. What is your first name?

* 2. What is your last name initial?

* 3. Add your email

* 4. What is your gender?

* 5. I get insecure about myself and my abilities

* 6. I am not able to pause or control my worry

* 7. I feel afraid something awful is going to happen

* 8. I cannot stop obsessing about difficult situations

* 9. I feel tense and agitated in my body

* 10. I don't sleep well

* 11. I feel physically exhausted from my anxiety

* 12. I over or under-eat trying to soothe my anxiety

* 13. I become easily annoyed

* 14. I feel nervous and on edge

* 15. I feel emotionally sensitive and vulnerable

* 16. I feel lonely and alone

* 17. I don't have a sense of spiritual connection

* 18. I feel a lack of meaning

* 19. I don't believe in a power greater than myself

* 20. I feel lost and without direction

* 21. What have I tried to manage my anxiety?

* 22. How would my life be different if I solved my anxiety

* 23. Am I willing to try something different than before to try and solve it?

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