Free Nervous System Assessment

Anxiety (GAD-7)

Over the last 2 weeks, how often have you been bothered by:

Feeling nervous, anxious, or on edge

Not at all Several days More than half the days Nearly every day

Not being able to stop or control worrying

Not at all Several days More than half the days Nearly every day

Worrying too much about different things

Not at all Several days More than half the days Nearly every day

Trouble relaxing

Not at all Several days More than half the days Nearly every day

Being so restless that it is hard to sit still

Not at all Several days More than half the days Nearly every day

Becoming easily annoyed or irritable

Not at all Several days More than half the days Nearly every day

Feeling afraid as if something awful might happen

Not at all Several days More than half the days Nearly every day

Stress (PSS-4)

In the last month, how often have you:

Felt that you were unable to control the important things in your life?

Never Almost never Sometimes Fairly often Very often

Felt confident about your ability to handle your personal problems?

Very often Fairly often Sometimes Almost never Never

Felt that things were going your way?

Very often Fairly often Sometimes Almost never Never

Felt difficulties were piling up so high that you could not overcome them?

Never Almost never Sometimes Fairly often Very often

How you've been feeling (PHQ-9)

Over the last 2 weeks, how often have you been bothered by:

Little interest or pleasure in doing things

Not at all Several days More than half the days Nearly every day

Feeling down, depressed, or hopeless

Not at all Several days More than half the days Nearly every day

Trouble falling or staying asleep, or sleeping too much

Not at all Several days More than half the days Nearly every day

Feeling tired or having little energy

Not at all Several days More than half the days Nearly every day

Poor appetite or overeating

Not at all Several days More than half the days Nearly every day

Feeling bad about yourself — or that you are a failure

Not at all Several days More than half the days Nearly every day

Trouble concentrating on things, such as reading or watching television

Not at all Several days More than half the days Nearly every day

Moving or speaking so slowly that others could notice — or being so restless you move around a lot more than usual

Not at all Several days More than half the days Nearly every day

Thoughts that you would be better off dead, or thoughts of hurting yourself

Not at all Several days More than half the days Nearly every day

Your patterns

When pressure builds, your default reaction is:

I shut down and feel frozen I get reactive or short-tempered I push through, even if running on empty I try to escape or distract myself I notice it and try to regulate

How do you feel in the first 30 minutes after waking up?

Wired but tired Heavy and slow to start Anxious or racing Calm and present Numb or disconnected

Cognitive clarity

How clear is your thinking right now?

5

Completely foggyPerfectly clear

A few safety questions

Have you experienced panic attacks in the last 30 days?

No Once Several times Frequently

Do you ever feel detached from yourself, your body, or your surroundings?

Never Occasionally Weekly Daily

Have you ever been diagnosed with bipolar disorder, or experienced periods of unusually high energy, decreased need for sleep, or impulsive behaviour?

No Unsure Yes

Your body

Where do you feel stress most in your body?

Select all that apply.

Jaw / face / neck Chest / heart Stomach / gut Head Arms / legs / hands I don't notice it in my body

About you

How old are you?

Under 18 18–29 30–44 45–59 60+

Your health

Do you have any known medical conditions?

Select all that apply.

Anxiety disorder Depression ADHD PTSD / trauma history Cardiovascular condition Thyroid / hormonal condition Autoimmune condition None

Are you currently taking any medication or supplements?

No Yes, prescribed medication Yes, supplements only Both

Which ones? (Helps us keep your protocol safe)

Your 30-day goal

Which areas would you like to focus on?

Select up to 3.

Reduce anxiety Sleep better More energy Better focus / clarity Emotional regulation Feel less overwhelmed Reconnect with my body Consistent self-care

How much energy do you realistically have for self-care this week?

Almost none Very little Moderate Plenty

What would you most like to achieve in the next 30 days?

One last step

Where should we send your results?

Your scores and nervous system state will be shown immediately. No spam, ever.

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