Once you sign-up, we will send you a confirmation email. Your Username will be recorded in the email for later reference. Your email address will be your password. There is a separate procedure to sign up for our Online Support Group. Please follow this link to review the Support Group User Agreement.

If you choose to use this application, we’ll have no way of knowing who you are. Also, we do not collect, review, reuse, or resell email addresses. If you would like to review our Privacy Policy, please click here.

We’ll now ask you a series of short questions. Your answers will be used in creating your Session Diary. After you sign-up, we will take you to The Anxiety Test. After you’ve completed The Anxiety Test you can begin working on Session One.

NOTE: If you’re already using The Panic Diary, please login to diary and click "The Panic Program" button located on your calendar. This will enable you to sign up to The Panic Program and use the data you have already entered into your diary.

Panic Program Sign-Up

  1. The User Name I’d like to use for this program is:
    (for privacy, please only use your first name or an alias)

  2. The email address I would like to use for this program is:
    (If you're concerned about your privacy, we suggest signing up for an anonymous Yahoo! or Hotmail email address)

  3. I am: female male

  4. My country:

  5. I am in this age range:

  6. In the past two weeks, I have had approximately this many panic attacks:

  7. In the past two weeks, I’d rate my average fear rating during a panic attack as:

    012345678910
    No
    Fear    		 Low
    Fear    		 Moderate
    Fear    		 Strong Fear Extreme Fear

  8. In the past two weeks my panic attacks have caused the following level of interference in my daily normal life:
    no interference
    mild / little interference
    moderate / medium interference
    considerable / much interference
    extreme / severe interference

  9. In the past two weeks my fear and/or avoidance of specific situations caused the following level of interference in my normal daily life:
    no interference
    mild / little interference
    moderate / medium interference
    considerable / much interference
    extreme / severe interference

  10. I have tried Cognitive Behavioral Therapy (CBT) in the past: Yes No

  11. I plan to use The Panic Program:
    on my own
    with my health care professional
    I am a health care professional reviewing the program

Please Note: By clicking "Sign-Up" you acknowledge that The Panic Program is for educational purposes only and is not be used as a substitute for a consultation or visit with your family physician or other health care provider. Please read this important legal information. Before participating in The Panic Program, we suggest that you consult with your physician or healthcare professional to ensure that your panic symptoms are not due to another illness.

This site is for educational purposes only and is not to replace the advice of a healthcare professional. Copyright 2001-2 by The Panic Center All Rights Reserved. U.S. and Canadian patents pending for The Anxiety Test, including related methods and software. All worldwide patent rights reserved.