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PROMIS-Parent
PROMIS Parent
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*
" indicates required fields
PROMIS Parent Proxy 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. My child felt nervous
*
Never
Almost Never
Sometimes
Often
Almost Always
2. My child felt scared
*
Never
Almost Never
Sometimes
Often
Almost Always
3. My child felt worried
*
Never
Almost Never
Sometimes
Often
Almost Always
4. My child felt like something awful might happen
*
Never
Almost Never
Sometimes
Often
Almost Always
5. My child worried when he/she was at home
*
Never
Almost Never
Sometimes
Often
Almost Always
6. My child got scared really easy
*
Never
Almost Never
Sometimes
Often
Almost Always
7. My child worried about what could happen to him/her
*
Never
Almost Never
Sometimes
Often
Almost Always
8. My child worried when he/she went to bed at night
*
Never
Almost Never
Sometimes
Often
Almost Always
