| Q1 | Q2 | Q3 | Q4 |
| Has that fear affected you? | How much has that fear affected you? | What effects has this fear had on you? | What are the biggest effects this fear has had on you? |
| Answer Choices: Yes, Maybe, No | Likert-scale Question (1-Not at all; 10-A lot) | M-S Question (see Appendix B for all answer choices) | Open-Ended Questions (see Appendix F for all responses) |