"*" indicates required fields

PROMIS Pediatric Item Bank v2.0 – Anxiety – Short Form 8a
Child's Name*
MM slash DD slash YYYY
Parent/Guardian's name*
MM slash DD slash YYYY

In the past 7 days…

1. I felt like something awful might happen.*
2. I felt nervous.*
3. I felt scared.*
4. I felt worried*
5. I worried when I was at home*
6. I got scared really easy*
7. I worried about what could happen to me*
8. I worried when I went to bed at night*