Burns Anxiety Inventory Rating Scale
The following is a list of symptoms that people sometimes have. put a check ( ) in the space to the right that best describes how much that symptom or problem has bothered you during the past week. if you would like a weekly record of your progress, record your answers on the separate sheets instead of filling in the space on the right.
Name *
Your answer
Email *
Your answer
Phone number *
Your answer
Date of Assessment *
MM
/
DD
/
YYYY
Appointment No. *
Your answer
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