PROMIS: Parent Proxy Anxiety: Short Form 8a

PROMIS: Parent Proxy Anxiety: Short Form 8a
Hello, and thank you for completing your forms prior to your appointment.

Below is the Parental Stress Scale. Parenting can be stressful, and we recognize that there are many factors that can influence parent stress. These topics can sometimes be difficult to think about. We are asking you to complete this questionnaire to help us understand how we can better support you and your child.

If you have questions or concerns, please talk to your child’s doctor.
Today's Date

MonthDayYear
Date
Patient Name:*

First NameLast Name
Patient DOB: *

MonthDayYear
Date
Who is completing this form? *

First NameLast Name

In the last 7 days.....*

	Never	Almost Never	Sometimes	Often	Almost Always
My child felt nervous
My child felt scared
My child felt worried
My child felt like something awful might happen
My child worried when he/she was at home
My child got scared really easily
My child worried about what could happen to him/her
My child worried when he/she went to bed at night