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PROMIS-Child
PROMIS Child
"
*
" indicates required fields
PROMIS Pediatric Item Bank v2.0 – Anxiety – Short Form 8a
Child's Name
*
First
Last
Child's Date of Birth
*
MM slash DD slash YYYY
Parent/Guardian's name
*
First
Last
Today's Date
*
MM slash DD slash YYYY
In the past 7 days…
1. I felt like something awful might happen.
*
Never
Almost Never
Sometimes
Often
Almost Always
2. I felt nervous.
*
Never
Almost Never
Sometimes
Often
Almost Always
3. I felt scared.
*
Never
Almost Never
Sometimes
Often
Almost Always
4. I felt worried
*
Never
Almost Never
Sometimes
Often
Almost Always
5. I worried when I was at home
*
Never
Almost Never
Sometimes
Often
Almost Always
6. I got scared really easy
*
Never
Almost Never
Sometimes
Often
Almost Always
7. I worried about what could happen to me
*
Never
Almost Never
Sometimes
Often
Almost Always
8. I worried when I went to bed at night
*
Never
Almost Never
Sometimes
Often
Almost Always
