Anxiety Questionnaire

Disorders and Conditions

News and Resources

Questions about a Disorder?

Anxiety Questionnaire

Get a personalized review of your results by a trained mental health professional for a fee. A comprehensive report will be delivered to you analyzing your reported symptoms and making recommendations to help you get back on track. Let our qualified staff assess your current state of mind and get you started on the road to recovery! Contact us via Concierge Services.

Demographics

I am:

Male Female

Age:

1. Do you feel that you worry excessively about many things?

No Yes

2. During the last 6 months, have you been persistently worrying or anxious about several different things (for example, finances, health, work, family, etc) most of the time and more so than other people would worry?

No Yes

3. Is it difficult for you to stop worrying about things?

No Yes

4. Is your constant worrying affecting your relationships, your work or other important parts of your life?

No Yes

5. Do you experience sudden episodes of intense and overwhelming fear that seem to come on for no apparent reason?

No Yes

6. Do you experience any of the following during these episodes: racing heart, chest pain, shortness of breath, choking sensation, dizziness, tingling or numbness?

No Yes

7. Do you have a fear of losing control of yourself or of going crazy

No Yes

8. Do you avoid social situations because you feel afraid?

No Yes

9. Do you have specific fears of certain things such as dogs or knives?

No Yes

10. Are you afraid that you will be in a situation where you will not be able to escape?

No Yes

11. Does the idea of leaving your house or apartment frighten you?

No Yes

12. Do you have recurrent thoughts or images in your head that refuse to go away?

No Yes

13. Have you experienced an frightening, upsetting event either recently or in the past that you relive over and over again?

No Yes

14. Do you become anxious when you face anything that reminds you of that traumatic event?

No Yes

15. Do you have any of the following symptoms: difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, feeling 'on guard', easily startled?

No Yes

16. Do you often feel restless and on edge even when there is nothing going on to cause these feelings?

No Yes

17. Is it difficult for you to fall asleep most nights due to too many thoughts and worries in your head?

No Yes

18. Do friends or family members tell you that you are too high strung, worry too much about little things, or need to 'chill'?

No Yes

	Insomnia
	ADHD
	Addiction
	Schizophrenia
	Anxiety
	Eating Disorder
	Panic
	Bipolar Disorder
	Depression
	OCD
	General Mental Health

Disorders and Conditions

News and Resources

Questions about a Disorder?

Anxiety Questionnaire

Demographics

Tools and Services

Newsletters

Mental Health Disorders

General Mental Health

Company