Full Name
*
Email
*
Phone
How often have you been upset because something that happened unexpectedly?
*
Never
Almost Never
Sometimes
Fairly often
Very often
How often have you felt that you were unable to control the important things in your life?
*
Never
Almost Never
Sometimes
Fairly often
Very often
How often have you felt nervous and “stressed”?
*
Never
Almost Never
Sometimes
Fairly often
Very often
How often have you felt confident about your ability to handle your personal problems?
*
Never
Almost Never
Sometimes
Fairly often
Very often
How often have you felt that things were going your way?
*
Never
Almost Never
Sometimes
Fairly often
Very often
How often have you found that you could not cope with all the things that you had to do?
*
Never
Almost Never
Sometimes
Fairly often
Very often
How often have you been able to control irritations in your life?
*
Never
Almost Never
Sometimes
Fairly often
Very often
How often have you felt that you were on top of things?
*
Never
Almost never
Sometimes
Fairly often
Very often
How often have you been angered because of things that were outside of your control?
*
Never
Almost never
Sometimes
Fairly often
Very often
How often have you felt difficulties were piling up so high that you could not overcome them?
Never
Almost Never
Sometimes
Fairly often
Very often
