This scale is a self-report measure of anxiety.

Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by the symptom during the past month, including today, by checking the numbe rin the corresponding space in the column next to each symptom.

Who will be participating?

Adult  Adult and Children  

Parent / Guardian Information

Feel free to add any comments regarding your experience prior to and after going to Warrior Ranch.

Sign Here

I certify that my answers are true and complete to the best of my knowledge. I authorize a background check through National Center for Safety Initiatives