PART A:  Are you troubled by:

Anxiety about being in places or situations that may be difficult or embarrassing to get out of, or in which you may not be able to get help if you develop panic-like symptoms?

PART B: Do you: 

Avoid places or situations where you fear you may have a panic attack?

Yes No

Endure situations that you can't avoid with extreme distress and anxiety?

Yes No

Require the presence of a companion to confront places and situations you can't avoid?

Yes No

PART C: Is your anxiety or avoidance:

Unrelated to another disorder, such as Social Phobia, Specific Phobia, OCD, or PTSD?

Yes No

Unrelated to a medical condition, medication, and substance use?

Yes No