First Name *

Last Name *

Email *

I find myself clenching my jaw or fists without noticing. *

Strongly DisagreeStrongly Agree

I feel calm and connected in nature or solitude. *

Strongly DisagreeStrongly Agree

I feel overwhelmed when my environment is chaotic. *

Strongly DisagreeStrongly Agree

I lose track of my own needs in relationships. *

Strongly DisagreeStrongly Agree

I use movement or breath to help regulate emotions. *

Strongly DisagreeStrongly Agree

I find it hard to feel what’s going on in my body. *

Strongly DisagreeStrongly Agree

I change how I behave to avoid conflict. *

Strongly DisagreeStrongly Agree

I often prioritize others’ needs over my own. *

Strongly DisagreeStrongly Agree

I worry about what others think of me. *

Strongly DisagreeStrongly Agree

I struggle to sit still or slow down. *

Strongly DisagreeStrongly Agree

I often use busyness or distraction to avoid discomfort. *

Strongly DisagreeStrongly Agree

I overthink or obsess about what might go wrong. *

Strongly DisagreeStrongly Agree

I avoid decisions because I fear making the wrong one. *

Strongly DisagreeStrongly Agree

I plan excessively in case things go wrong. *

Strongly DisagreeStrongly Agree

I go blank or numb when overwhelmed. *

Strongly DisagreeStrongly Agree

I feel foggy or disconnected from my body. *

Strongly DisagreeStrongly Agree

My body feels tight or braced throughout the day. *

Strongly DisagreeStrongly Agree

I feel like I’m always on the move, even mentally. *

Strongly DisagreeStrongly Agree

I get irritated when I feel out of control. *

Strongly DisagreeStrongly Agree

I often feel a rush of energy when something feels wrong. *

Strongly DisagreeStrongly Agree

I tend to assert myself forcefully in tense situations. *

Strongly DisagreeStrongly Agree

I sometimes feel paralyzed and unsure of what to do. *

Strongly DisagreeStrongly Agree

I often freeze in social or emotional situations. *

Strongly DisagreeStrongly Agree

I struggle to say no, even when I want to. *

Strongly DisagreeStrongly Agree

I scan people’s faces to see if they’re upset. *

Strongly DisagreeStrongly Agree

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