Separation Anxiety Measure Worksheet

Severity Measure for Separation Anxiety Disorder—Adult

  • Date Format: MM slash DD slash YYYY
  • The following questions ask about thoughts, feelings, and behaviors that you may have had about being separated from home or from people who are important to you. Please rate how often the following statements are true for you. During the past SEVEN (7) DAYS, I have...
  • Input the value that best fits you, (0) Never, (1) Occasionally, (2) Half of the time, (3) Most of the time, (4) All of the time.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
  • Please enter a number from 0 to 4.
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