How much fear or anxiety do you feel using a telephone in public?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid using a telephone in public?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel participating in a small group activity?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid participating in a small group activity?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel eating in public?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid eating in public?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel drinking with others?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid drinking with others?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel talking to someone in authority?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid talking to someone in authority?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel acting, performing or speaking in front of an audience?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid acting, performing or speaking in front of an audience?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel going to a party?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid going to a party?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel working while being observed?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid working while being observed?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel writing while being observed?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid writing while being observed?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel calling someone you don't know very well?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid calling someone you don't know very well?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel talking face to face with someone you don't know very well?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid talking face to face with someone you don't know very well?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel meeting strangers?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid meeting strangers?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel urinating in a public bathroom?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid urinating in a public bathroom?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel entering a room when others are already seated?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid entering a room where others are already seated?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel being the center of attention?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid being the center of attention?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel speaking up at a meeting?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid speaking up at a meeting?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel taking a test of your ability, skill or knowledge?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid taking a test of your ability, skill or knowledge?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel expressing disagreement or disapproval to someone you don't know very well?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid expressing disagreement or disapproval to someone you don't know very well?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel looking someone who you don't know very well straight in the eyes?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid looking someone who you don't know very well straight in the eyes?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel giving a prepared oral talk to a group?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid giving a prepared oral talk to a group?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel trying to make someone's acquaintance for the purpose of a romantic/sexual relationship?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid trying to make someone's acquaintance for the purpose of a romantic/sexual relationship?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel returning goods to a store for a refund?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid returning goods to a store for a refund?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel giving a party?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid giving a party?
Please select your answer
Never
Occasionally
Often
Usually
How much fear or anxiety do you feel resisting a high pressure sales person?
Please select your answer
None
Mild
Moderate
Severe
How often do you avoid resisting a high pressure sales person?
Please select your answer
Never
Occasionally
Often
Usually
