1.

Does you heart, beats faster than usual?

Yes / No

2.

Do you have frequent body aches?

Yes / No

3.

Have you become more irritable lately?

Yes / No

4.

Do you have frequent headaches?

Yes / No

5.

Are you suffering from loss of self-confidence, of late?

Yes / No

6.

Is there a loss of appetite?

Yes / No

7.

Have you lost concentration in work and/or other activities?

Yes / No

8.

Do you sweat a lot even without physical activities?

Yes / No

9.

Have you lost interest in activities and/or hobbies, which you earlier enjoyed?

Yes / No

10.

Do you feel downhearted, depressed, blue or sad?

Yes / No

11.

Are you losing weight?

Yes / No

12.

Is there a loss of sleep?

Yes / No

13.

Do you get bad and negative thoughts?

Yes / No

14.

Do you happen to forget things easily?

Yes / No

15.

Do you get tired easily for no reason?

Yes / No

16.

Do you have trouble with constipation?

Yes / No

17.

Do you get bad and horrifying dreams which trouble you during working hours?

Yes / No

18.

Do you wake up early in the morning without reason?

Yes / No

19.

Is your sexual interest/desire reduced?

Yes / No

20.

Do you feel like crying frequently?

Yes / No

21.

Do you become restless and cannot keep still?

Yes / No

22.

Do you think too much and spend most of your time worrying about the past and/or future?

Yes / No

23.

Do you find it hard to take decisions?

Yes / No

24.

Do you consume alcohol, or any other substance to suppress your nervousness/tension?

Yes / No

25.

Do you feel that others would be better off if you were dead?

Yes / No