1. How often do you delay or cancel an airplane trip due to your fear of flying?

• Never/rarely (less than 10% of the time)
• Sometimes (up to 50%)
• Usually
• Always - I've never flown

2. When planning an airplane trip, when do you notice you have a nervous fear of flying?

• Just thinking about flying makes me too nervous to plan a trip
• When I make the reservations
• As I travel to the airport
• I'm okay until I get on the airplane
• I don't get nervous planning an airplane trip

3. My fear of flying is based on the belief that:

• Flying is inherently dangerous
• Flying involves a loss of control
• Flying is about a fear of the unknown
• I don't have a fear of flying

4. Do you have other significant fears other than being nervous about flying, such as fear of heights, claustrophobia, agoraphobia, etc.?

• No, just a fear of flying
• Yes, I don't like being "closed up" inside the airplane
• Yes, I have one or more other fears
• I have no fears about flying

5. Do you believe that you can get over your fear of flying anxiety?

• No
• Yes
• Maybe
• I have no anxiety about flying

6. Please rate your personal level of anxiety about flying.

• None (perfectly calm under all circumstances of flying)
• Low (butterflies in the stomach)
• Moderate (definite nervousness)
• High (pounding heart, sweating, etc.)
• Extreme (panic attacks, inability to think clearly and function normally)