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Anxiety Symptoms Inventory (21 questions)
Below is a list of common symptoms of anxiety. Please carefully read each symptom and indicate how much you have been bothered by that symptom during the past month, including today.
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Name
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First
Last
Email
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Phone Number
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Numbness or tingling
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Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Feeling hot
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Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Wobbliness in legs
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Unable to relax
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Fear of worst happening
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Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Dizzy or lightheaded
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Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Heart pounding / racing
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Unsteady
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Terrified or afraid
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Nervous
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Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Feeling of choking
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Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Hands trembling
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Shaky / Unsteady
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Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Fear of losing control
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Difficulty in breathing
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Fear of dying
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Scared
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Indigestion
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Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Faint / lightheaded
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Face flushed
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
Hot / cold sweats
*
Not at all
Mildly, but it didn't bother me much
Moderately - it wasn't pleasant at times
Severely - it bothered me a lot
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