Grab a pen and paper✍️ — you’ll be keeping track of your own points!Note: This assessment does NOT track your score for you, so make sure you're tallying as you go!
✍️ YOU NEED TO GRADE YOUR ASSESSMENT !
Question 1 of 24
1. How often do you feel nervous, anxious, or on edge?
Never (0 pts)
Rarely (1 pt)
Sometimes (2 pts)
Frequently (3 pts)
All Day (4 pts)
Question 2 of 24
2. How often do you focus on symptoms or how you feel?
Rarely (1 pts)
All day (4 pts)
Question 3 of 24
3. How often do you experience panic attacks, sudden episodes of intense fear or discomfort?
Pretty much all day (4 pts)
Question 4 of 24
4. Do you avoid certain situations, foods, places or activities because of anxiety or fear of symptoms?
No, never (0 pts)
Everyday (4 pts)
Question 5 of 24
5. How often do you experience a racing heartbeat, heart palpitations, shortness of breath or chest discomfort?
No, Never (0 pts)
Multiple times a day (4 pts)
Question 6 of 24
6. How often do you experience sleep disturbances, such as difficulty falling asleep, staying asleep, or waking up feeling tired?
Never, I sleep great! (0 pts)
Every night (4 pts)
Question 7 of 24
7. How often do you feel irritable, restless, scattered, or rush around even when there is no apparent reason?
Never, I am calm and relaxed (0 pts)
Question 8 of 24
8. How often do you feel easily overwhelmed by daily life?
Never (0 pt)
Question 9 of 24
9. How often do you find it difficult to concentrate or focus on tasks or activities?
Never, I have great focus (0 pts)
Pretty much all the time (4 pts)
Question 10 of 24
10. How often do you experience negative thoughts, such as worry about the future, or fear of losing control?
Rarely (1pt)
Question 11 of 24
11. How often do you experience sensitivities, to light, sound, chemicals or EMF exposure?
Question 12 of 24
12. Do you experience sensitivities to foods you used to enjoy?
No, Praise God! (0 pts)
Yes (4 pts)
Question 13 of 24
13. How often do you experience dizziness, lightheadedness, dizziness upon standing?
All the time (4 pts)
Question 14 of 24
14. Do you find you are prone to illness, or frequently catching colds or other infections?
No, I haven't been sick in years (0 pts)
I rarely get sick-maybe once a year or less (1 pt)
I get sick a few times a year but I usually recovery quickly (2 pts)
I get sick frequently-more than a few times a year and it tends to linger. (3 pts)
I am almost always battling something-colds, infections, flares (4 pts)
Question 15 of 24
15. How often do you struggle with headaches or migraines?
Question 16 of 24
16. How often do you experience pain, burning, sore, or tense muscles or joint aches?
Never, or only after a good workout (0 pts)
Sometimes in the morning (2 pts)
Question 17 of 24
17. How often do you wake up in the morning feeling exhausted or with increased symptoms
I feel great in the morning (0 pts)
Every Morning (4 pts)
Question 18 of 24
18. How often do you turn to medications, supplements or substances for symptom control?
Question 19 of 24
19. How often do you feel stuck in a ruminating thought cycle, unable to quiet the mind?
Mostly All day and night (4 pts)
Question 20 of 24
20. How often do you experience fatigue that is not relieved by rest?
Question 21 of 24
21. How often do you experience a depressed mood, apathy, or flat affect?
Question 22 of 24
22. How often do you experience nausea or gastrointestinal distress?
Question 23 of 24
23. How often do symptoms hinder your ability to work or do the things you enjoy
I cannot work, at this time (4 pts)
Question 24 of 24
24. How often do you feel disconnected from God?
I haven't felt connected in a long time (4pts)