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self evaluation form

Dear Sir / Madam, please take a few minutes to complete the next survey.

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Test your fear of driving
1

Are you in possession of a driver's license?

2

How would you like to judge your general selfconfidence while driving?

3

How often do you drive on average per week?

4

Which of the following situations cause driving anxiety?

Choose one or more answers
5

Do you experience physical symptoms while driving?

Choose one or more answers
6

Have you ever spoken to someone about your fear of driving?

7

Would you consider looking for professional help for your fear of driving?

8

What are your goals with regard to driving?

9

How satisfied are you at the moment with your driving experience so far?

10

Is there anything else that you would like to share about your fear of driving or your experience in driving?

Write your answer here
11

Personal

12

Age category

13

Name and residence

14

Telephone

15

E-mail adress

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