Anxiety and Everyday Well-Being Check-In
Tell us how you’ve felt over the past two weeks. You may skip any question; this survey is not a diagnosis.
How often have you felt nervous or on edge?
Think about your everyday experiences over the past two weeks.
How much has anxiety disrupted your daily routine?
Consider activities such as work, study, household tasks, or spending time with others.
Which situations have made you feel anxious?
Select all that apply to the past two weeks. Choose “None of these” only if no other option applies.
How often has it been hard to stop worrying?
Think about times when worries kept coming back, even when you tried to set them aside.
What helps you feel calmer?
Select all that have helped you over the past two weeks.
How much has anxiety affected your sleep?
Consider trouble falling asleep, waking during the night, or feeling unrested because of worry.
How easy is it to get support when you feel anxious?
Support could come from people you trust, your organization, or professional services.
What could we change to help you feel more at ease?
Share any practical changes or support you would find helpful. Please avoid including names or private medical details.
Thank you for taking a part in this survey.
