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* 1. What is your first name?

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* 2. What is your last name initial?

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* 3. Add your email

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* 4. What is your gender?

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* 5. I get insecure about myself and my abilities

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

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

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* 8. I cannot stop obsessing about difficult situations

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* 9. I feel tense and agitated in my body

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* 10. I don't sleep well

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* 11. I feel physically exhausted from my anxiety

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

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* 13. I become easily annoyed

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* 14. I feel nervous and on edge

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* 15. I feel emotionally sensitive and vulnerable

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* 16. I feel lonely and alone

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

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* 18. I feel a lack of meaning

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

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* 20. I feel lost and without direction

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

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

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

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