1 – No
2 – A little
3 – Some
4 – Often
5 – Severe
¹
1
2
3
4
5
1
Do you think there is something seriously wrong with your body?
2
Do you worry a lot about your health?
3
Is it hard for you to believe the doctor when he tells you there is nothing to worry about?
4
Do you often worry about the possibility that you have a serious illness?
5
Are you bothered by many different pains and aches?
6
If a disease is brought to your attention (e.g., on TV, radio, the newspapers, or by someone you know), do you worry about getting it yourself?
7
Do you find that you are bothered by many different symptoms?
8
Do you have recurring thoughts about having a disease that are difficult to get rid of?
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.