[av_heading heading=’Anxiety Screener’ tag=’h2′ style=’blockquote modern-quote’ size=” subheading_active=” subheading_size=’15’ padding=’10’ color=” custom_font=” admin_preview_bg=”][/av_heading]
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[av_contact email=’drfodio@gmail.com’ title=’Over the last 2 weeks, how often have you been bothered by the following problems?’ button=’Submit’ on_send=” sent=’Your message has been sent!’ link=’manually,http://’ subject=’Anxiety Screener’ autorespond=” captcha=” form_align=” color=”]
[av_contact_field label=’Feeling nervous, anxious, or on edge’ type=’select’ options=’Not at all,Several Days,More than half the days,Nearly every day’ check=” width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Not being able to stop or control worrying’ type=’select’ options=’Not at all,Several Days,More than half the days,Nearly every day’ check=” width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Worrying too much about different things’ type=’select’ options=’Not at all,Several Days,More than half the days,Nearly every day’ check=” width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Trouble relaxing’ type=’select’ options=’Not at all,Several Days,More than half the days,Nearly every day’ check=” width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Being so restless that it is hard to sit still’ type=’select’ options=’Not at all,Several Days,More than half the days,Nearly every day’ check=” width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Becoming easily annoyed or irritable’ type=’select’ options=’Not at all,Several Days,More than half the days,Nearly every day’ check=” width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Feeling afraid as if something awful might happen’ type=’select’ options=’Not at all,Several Days,More than half the days,Nearly every day’ check=” width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Name’ type=’text’ check=’is_empty’ options=” multi_select=” width=”][/av_contact_field]
[av_contact_field label=’E-Mail’ type=’text’ options=” check=’is_email’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Phone’ type=’text’ options=” check=’is_phone’ width=” multi_select=”][/av_contact_field]
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[av_image src=’https://patsconsultants.com/wp-content/uploads/2016/09/image09259191840.jpg’ attachment=’1198′ attachment_size=’full’ align=’center’ styling=” hover=” link=” target=” caption=” font_size=” appearance=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’][/av_image]
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