Rate My Anxiety
Email address *
Please print your name and phone number *
Your answer
I feel agitated, tense, or restless more than twice a week
Almost Never
Always
I'm afraid for no apparent reason
Almost Never
Always
I worry about bad things that might happen tome or those I care about
Almost Never
Always
I have difficulty falling asleep, staying asleep or waking up early
Almost Never
Always
I have difficulty eating too much, too little or digesting my food
Almost Never
Always
I wish I knew a way to make myself more relaxed
Almost Never
Always
I have difficulty with my concentration,memory or thinking
Almost Never
Always
I would say I am anxious much of the time
Almost Never
Always
From time to time I have experienced a racing heartbeat, cold hands or feet, dry mouth,sweating, tight muscles, difficulty breathing,numbness, frequent urination, or hot/cold flashes
Almost Never
Always
I wish I could be as relaxed with myself as others seem to be
Almost Never
Always
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy