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Stress Management Consulting
Anxiety Symptoms: BAI Form

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.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Numbness or tingling *

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 *

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 *

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 *

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 *

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 *

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 *

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 *

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

Submit

704-996-4079

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